記述言語：日本語   掲載種別：研究論文（学術雑誌）  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A better understanding of the relative contributions of various factors to patient outcomes is essential for optimal patient selection for extracorporeal cardiopulmonary resuscitation (ECPR) therapy for patients with out-of-hospital cardiac arrest (OHCA). However, evidence on the prognostic comparison based on the etiologies of cardiac arrest is limited. RESEARCH QUESTION: What is the etiology-based prognosis of patients undergoing ECPR for OHCA? STUDY DESIGN AND METHODS: This retrospective multicenter registry study involved 36 institutions in Japan and included all adult patients with OHCA who underwent ECPR between January 2013 and December 2018. The primary etiology for OHCA was determined retrospectively from all hospital-based data at each institution. We performed a multivariable logistic regression model to determine the association between etiology of cardiac arrest and two outcomes: favorable neurological outcomes and survival at hospital discharge. RESULTS: We identified 1,781 eligible patients, of whom 1,405 (78.9%) had cardiac arrest due to the cardiac causes. Multivariable logistic regression analysis for favorable neurological outcomes showed that accidental hypothermia (adjusted OR = 5.12; 95% CI = 2.98-8.80, P < 0.001) was associated with a significantly higher rate of favorable neurological outcomes than cardiac causes. Multivariable logistic regression analysis for survival showed that accidental hypothermia (adjusted OR = 5.19; 95% CI = 3.15-8.56, P < 0.001) had significantly higher rates of survival than cardiac causes. Acute aortic dissection/aneurysm (adjusted OR = 0.07, 95% CI = 0.02-0.28, P < 0.001) and primary cerebral disorders (adjusted OR = 0.12, 95% CI = 0.03-0.50, P = 0.004) had significantly lower rates of survival than cardiac causes. INTERPRETATION: In this retrospective multicenter cohort study, although most OHCA patients underwent ECPR for cardiac causes, accidental hypothermia was associated with favorable neurological outcomes and survival; in contrast, acute aortic dissection/aneurysm and primary cerebral disorders were associated with non-survival than cardiac causes.

DOI： 10.1016/j.chest.2023.10.022

PubMed

researchmap

記述言語：英語  

Injuries of the celiac artery and its branches are rare, but potentially lethal. Ligation of these arteries is performed to control significant hemorrhage. However, few reports have described the adverse effects of ligating these arteries. A 69-year-old woman with a self-inflicted stab wound was brought to our hospital. Her blood pressure could not be measured, therefore aortic cross-clamping was performed, and epinephrine was administered for resuscitation, an emergency laparotomy was performed, and the roots of splenic artery and common hepatic artery were ligated. The left gastric artery which was anomalous and arose directly from the aorta, was also injured and had to be ligated. Norepinephrine was required after the surgery. Enhanced computed tomography performed on hospital day 4 revealed a disrupted celiac artery. The patient developed gastric necrosis on hospital day 23 and, hence, underwent total gastrectomy was performed. The possibility of delayed stomach necrosis should be considered during the postoperative management of patients who undergo ligation of all of the celiac artery branches and experience global hypoperfusion after the surgery.

DOI： 10.1016/j.tcr.2023.100904

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is reportedly associated with air leak syndrome (ALS), including mediastinal emphysema and pneumothorax, and has a high mortality rate. In this study, we compared values obtained every minute from ventilators to clarify the relationship between ventilator management and risk of developing ALS. METHODS: This single-center, retrospective, observational study was conducted at a tertiary care hospital in Tokyo, Japan, over a 21-month period. Information on patient background, ventilator data, and outcomes was collected from adult patients with SARS-CoV-2 pneumonia on ventilator management. Patients who developed ALS within 30 days of ventilator management initiation (ALS group) were compared with those who did not (non-ALS group). RESULTS: Of the 105 patients, 14 (13%) developed ALS. The median positive-end expiratory pressure (PEEP) difference was 0.20 cmH2O (95% confidence interval [CI], 0.20-0.20) and it was higher in the ALS group than in the non-ALS group (9.6 [7.8-20.2] vs. 9.3 [7.3-10.2], respectively). For peak pressure, the median difference was -0.30 cmH2O (95% CI, -0.30 - -0.20) (20.4 [17.0-24.4] in the ALS group vs. 20.9 [16.7-24.6] in the non-ALS group). The mean pressure difference of 0.0 cmH2O (95% CI, 0.0-0.0) (12.7 [10.9-14.6] vs. 13.0 [10.3-15.0], respectively) was also higher in the non-ALS group than in the ALS group. The difference in single ventilation volume per ideal body weight was 0.71 mL/kg (95% CI, 0.70-0.72) (8.17 [6.79-9.54] vs. 7.43 [6.03-8.81], respectively), and the difference in dynamic lung compliance was 8.27 mL/cmH2O (95% CI, 12.76-21.95) (43.8 [28.2-68.8] vs. 35.7 [26.5-41.5], respectively); both were higher in the ALS group than in the non-ALS group. CONCLUSIONS: There was no association between higher ventilator pressures and the development of ALS. The ALS group had higher dynamic lung compliance and tidal volumes than the non-ALS group, which may indicate a pulmonary contribution to ALS. Ventilator management that limits tidal volume may prevent ALS development.

DOI： 10.1186/s12890-023-02549-7

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本臨床救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本臨床救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本臨床救急医学会  

researchmap

担当区分：筆頭著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The effect of posterior cranial fossa stroke on changes in cerebral volume is not known. We assessed cerebral volume changes in patients with acute posterior fossa stroke using CT scans, and looked for risk factors for cerebral atrophy. METHODS: Patients with cerebellar or brainstem hemorrhage/infarction admitted to the ICU, and who underwent at least two subsequent inpatient head CT scans during hospitalization were included (n = 60). The cerebral volume was estimated using an automatic segmentation method. Patients with cerebral volume reduction > 0% from the first to the last scan were defined as the "cerebral atrophy group (n = 47)," and those with ≤ 0% were defined as the "no cerebral atrophy group (n = 13)." RESULTS: The cerebral atrophy group showed a significant decrease in cerebral volume (first CT scan: 0.974 ± 0.109 L vs. last CT scan: 0.927 ± 0.104 L, P < 0.001). The mean percentage change in cerebral volume between CT scans in the cerebral atrophy group was -4.7%, equivalent to a cerebral volume of 46.8 cm3, over a median of 17 days. The proportions of cases with a history of hypertension, diabetes mellitus, and median time on mechanical ventilation were significantly higher in the cerebral atrophy group than in the no cerebral atrophy group. CONCLUSIONS: Many ICU patients with posterior cranial fossa stroke showed signs of cerebral atrophy. Those with rapidly progressive cerebral atrophy were more likely to have a history of hypertension or diabetes mellitus and required prolonged ventilation.

DOI： 10.1007/s00701-023-05609-3

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本インターベンショナルラジオロジー学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Foreign body airway obstruction (FBAO) is a life-threatening emergency, and the prognosis of patients with FBAO is greatly affected by the prehospital process. There are only a few large-scale studies analyzing prehospital process databases of the fire department. STUDY OBJECTIVE: The aim of this study was to investigate whether characteristics of patients with FBAO were associated with prehospital factors and outcomes. METHODS: In this retrospective observational study, patients transferred to the hospital by the Tokyo, Japan Fire Department for FBAO from 2017 through 2019 were included. The association between neurologically favorable survival among the characteristics of patients with FBAO and prehospital factors affecting the outcomes was evaluated. RESULTS: Of the 2,429,175 patients, 3,807 (0.2%) patients had FBAO. The highest number of FBAO cases was 99 (2.6%), which occurred on January 1 (New Year's Day), followed by 40 cases (1.1%) on January 2, and 28 cases (0.7%) on January 3. The number of patients who experienced out-of-hospital cardiac arrest (OHCA) caused by FBAO was 1,644 (43.2%). Comparing the OHCA and non-OHCA groups, there were significant differences in age, sex, time spent at the site, and distance between the site and hospital. Cardiac arrest was significantly lower in infants after FBAO (P < .001). In total, 98.2% of patients who did not have return of spontaneous circulation (ROSC) before hospital arrival died within 30 days, a significantly higher mortality rate than that in patients who had ROSC (98.2% versus 65.8%; P < .001). CONCLUSIONS: Among patients who did not have ROSC following FBAO upon arrival at the hospital, 98.2% died within 30 days. Thus, it is important to remove foreign bodies promptly and provide sufficient ventilation to the patient at the scene to increase the potential for ROSC. Further, more precautions should be exercised to prevent FBAO at the beginning of the year.

DOI： 10.1017/S1049023X23000353

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Trauma is a serious medical and economic problem worldwide, and patients with trauma injuries have a poor survival rate following cardiac arrest. This study aimed to create a prediction model specific to prehospital trauma care and to achieve greater accuracy with techniques of machine learning. METHODS: This retrospective observational study investigated data of patients who had blunt trauma injuries due to traffic accident and fall trauma from January 1, 2018, to December 31, 2019, using the National Emergency Medical Services Information System, which stores emergency medical service activity records nationwide in the United States. Random forest was used to develop a machine learning model. RESULTS: Per the prediction model, the area under the curve of the predictive model was 0.95 and negative predictive value was 0.99. The feature importance of the predictive model was the highest for the AVPU scale (an acronym from "Alert, Verbal, Pain, Unresponsive"), followed by oxygen saturation (SpO2). Among patients who were progressing to cardiac arrest, the cutoff value was 89% for SpO2 in unalert patients. CONCLUSIONS: Patients whose conditions did not progress to cardiac arrest could be identified with high accuracy by machine learning model techniques.

DOI： 10.1272/jnms.JNMS.2023_90-206

PubMed

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1097/md.0000000000032850

researchmap

記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

researchmap

記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

researchmap

記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

出血性十二指腸潰瘍の主たる責任動脈は,胃十二指腸動脈および上腸間膜動脈から分枝する膵十二指腸動脈系である。今回我々は,十二指腸潰瘍が胆嚢動脈へ穿通し,血管内治療を要した稀な1例を経験したため報告する。症例は70歳代の男性。遠位胆管癌による閉塞性黄疸のため前医入院中に,出血性十二指腸潰瘍と急性腎不全を併発し集中治療目的に当院へ紹介となった。前医で十二指腸球部の露出血管に内視鏡的クリッピング術が施行されていたが,完全な止血は得られていなかった。当院搬入後の緊急内視鏡でも多量の血餅の存在から視野が確保できず,血管造影を施行した。上腸間膜動脈,胃十二指腸動脈造影では血管外漏出像を認めず,胆嚢動脈造影で十二指腸内腔まで造影される血管外漏出像を認め,NBCAを用いて塞栓し止血を得た。凝固障害を呈しており,止血術と輸血により凝固能を改善させた後,第2病日に胆嚢摘出術および十二指腸潰瘍部穿孔に対する大網充填術を施行した。術後全身状態の安定化を得た後に,遠位胆管癌に対する加療目的に第19病日に消化器外科へ転科した。本症例の責任病変は十二指腸の栄養血管ではなく,隣接する胆嚢の栄養血管であった。胆嚢動脈が出血性十二指腸潰瘍の責任動脈であることは稀である。胆嚢動脈からの出血は内視鏡止血が困難であり,血管内治療と手術を前提とした治療戦略の構築が有用である。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

researchmap

記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

We previously developed a risk assessment tool to predict outcomes after heat-related illness (J-ERATO score), which consists of six binary prehospital vital signs. We aimed to evaluate the ability of the score to predict clinical outcomes for hospitalized patients with heat-related illnesses. In a nationwide, prospective, observational study, adult patients hospitalized for heat-related illnesses were registered. A binary logistic regression model and receiver operating characteristic (ROC) curve analysis were used to assess the relationship between the J-ERATO and survival at hospital discharge as a primary outcome. Among eligible patients, 1244 (93.0%) survived to hospital discharge. Multivariable logistic regression analysis revealed that the J-ERATO was an independent predictor for survival to discharge (adjusted odds ratio [OR] 0.47; 95% confidence interval [CI] 0.37-0.59) and occurrence of disseminated intravascular coagulation (DIC) on day 1 (adjusted OR 2.07; 95% CI 1.73-2.49). ROC analyses revealed an optimal J-ERATO cut-off of 5 for prediction of mortality at discharge (area under the curve [AUC] 0.742; 95% CI 0.691-0.787) and DIC development on day 1 (AUC 0.723; 95% CI 0.684-0.758). The J-ERATO obtained before transportation could be helpful in predicting the severity and mortality of hospitalized patients with heat-related illnesses.

DOI： 10.1038/s41598-023-28498-z

PubMed

researchmap

記述言語：日本語   出版者・発行元：一般社団法人 日本外傷学会  

【はじめに】近年, Virtual reality (VR) を用いた医学教育の学習効果が期待されている. 【目的】外傷診療におけるVR教育のニーズや課題を探索する. 【方法】第36回日本外傷学会総会・学術集会イブニングセミナー (2022年6月30日) にて3施設からのVRを用いた外傷診療に関する講義を行い, アンケート調査を実施した. 対象は医師とし, 所属施設別と年代別で検討した. 【結果】セミナー参加者は102名, 医師からの有効回答数は79であった. 治療手技に焦点を当てたコンテンツが79名中32名 (40.5%) と最もニーズはあったが, 大学病院所属者からのニーズは30名中8名 (26.7%) と少なかった. VR動画の編集時間に関しては, 所属施設や年代に関係なく作業時間がとれないまたは作業時間がとれても週に2時間未満という回答が約60%であった. 【結論】治療手技のニーズは全体では高いが, 所属施設別での検討では異なった. VR教育への期待は高いが, VRの編集時間の確保が課題となった.

DOI： 10.11382/jjast.37.1_02

CiNii Research

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1002/ams2.820

researchmap

その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ams2.820

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Both coronavirus disease 2019 (COVID-19) and heat stroke have symptoms of fever or hyperthermia and the difficulty in distinguishing them could lead to a strain on emergency medical care. To mitigate the potential confusion that could arise from actions for preventing both COVID-19 spread and heat stroke, particularly in the context of record-breaking summer season temperatures, this work offers new knowledge and evidence that address concerns regarding indoor ventilation and indoor temperatures, mask wearing and heat stroke risk, and the isolation of older adults. Specifically, the current work is the second edition to the previously published guidance for handling heat stroke during the COVID-19 pandemic, prepared by the "Working group on heat stroke medical care during the COVID-19 epidemic," composed of members from four organizations in different medical and related fields. The group was established by the Japanese Association for Acute Medicine Heatstroke and Hypothermia Surveillance Committee. This second edition includes new knowledge, and conventional evidence gleaned from a primary selection of 60 articles from MEDLINE, one article from Cochrane, 13 articles from Ichushi, and a secondary/final selection of 56 articles. This work summarizes the contents that have been clarified in the prevention and treatment of infectious diseases and heat stroke to provide guidance for the prevention, diagnosis, and treatment of heat stroke during the COVID-19 pandemic.

DOI： 10.1002/ams2.827

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Patients with acute myocardial infarction (AMI) triaged as life-threatening are transferred to our emergency medical care center (EMCC). However, data on these patients remain limited. We aimed to compare the characteristics and AMI prognosis of patients transferred to our EMCC with those transferred to our cardiovascular intensive care unit (CICU) using whole and propensity-matched cohorts.We analyzed the data of 256 consecutive AMI patients transferred from the scene to our hospital by ambulance between 2014 and 2017. The EMCC and CICU groups comprised 77 and 179 patients, respectively. There were no significant between-group age or sex differences. Patients in the EMCC group had more disease severity score and had the left main trunk identified as the culprit more frequently (12% versus 0.6%, P < 0.001) than those in the CICU group; however, the number of patients with multiple culprit vessels did not differ. The EMCC group had a longer door-to-reperfusion time (75 [60, 109] minutes versus 60 [40, 86] minutes, P< 0.001) and a higher in-hospital mortality (19% versus 4.5%, P < 0.001), especially from non-cardiac causes (10% versus 0.6%, P < 0.001), than the CICU group. However, peak myocardial creatine phosphokinase did not significantly differ between the groups. The EMCC group had a significantly higher 1-year post-discharge mortality than the CICU group (log-rank, P = 0.032); this trend was maintained after propensity score matching, although the difference was not statistically significant (log-rank, P = 0.094).AMI patients transferred to the EMCC exhibited more severe disease and worse overall in-hospital and non-cardiac mortality than those transferred to the CICU.

DOI： 10.1536/ihj.22-654

PubMed

researchmap

記述言語：英語  

BACKGROUND: Diabetic ketoacidosis (DKA) is associated with a high mortality rate, especially if cerebral edema develops during the disease course. It is rarer and more severe in adults than in children. We present cases of two patients with cerebral edema-related DKA. CASE PRESENTATION: The first patient was a 38-year-old man with diabetes mellitus who presented with DKA-related disturbed consciousness. Although glycemic correction was performed slowly, he showed pupil dilation 11 h later. He underwent emergency ventricular drainage, but died of cerebral herniation. The second patient was a 25-year-old woman who presented with impaired consciousness secondary to DKA. Head computed tomography showed subarachnoid hemorrhage and cerebral edema. No related intraoperative findings were observed; it was concluded that the first computed tomography scan revealed pseudo-subarachnoid hemorrhage. CONCLUSION: Diabetic ketoacidosis-related cerebral edema develops despite treatment according to guidelines and is difficult to predict. Therefore, adult patients should be treated cautiously during DKA management.

DOI： 10.1002/ams2.860

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Persistent inflammation, immunosuppression, and catabolism syndrome (PICS) has impacted on long-term prognosis of patients with trauma. We aimed to identify patients with trauma at risk of PICS-related complications early in the intensive care unit (ICU) course. METHODS: A single-center retrospective cohort study was conducted. All consecutive patients with trauma who had stayed in the ICU for >7 days were included in the study. We developed the prediction score for the incidence of PICS-related outcomes in the derivation cohort for the initial period and then evaluated in the validation cohort for the subsequent period. Other outcomes were also assessed using the score. RESULTS: In total, 170 and 133 patients were included in the derivation and validation cohorts, respectively. The prediction score comprised the variables indicating PICS presence, including a maximum value of C-reactive protein >15 mg/dL, minimum value of albumin <2.5 g/dL, and an episode of nosocomial infection for the first 7 days after admission. A score of 1 was assigned to each variable. The area under the receiver operating characteristic curve of the score to predict PICS incidence was 0.74 (95% CI 0.66 to 0.81) and 0.72 (95% CI 0.64 to 0.81) in the derivation and validation cohorts, respectively. The higher score was also significantly associated with a higher Sequential Organ Failure Assessment score at day 14, a longer duration of mechanical ventilation, a longer length of stay in ICU, and experienced multiple episodes of infection. Similar results were obtained in the validation cohort. CONCLUSIONS: Our scoring system could predict the outcomes associated with PICS among patients with trauma. Because the score comprised the parameters measured for the first 7 days during the ICU course, it could contribute to identifying patients at a high risk of unfavorable outcome earlier. LEVEL OF EVIDENCE: Multivariate prediction models; level IV.

DOI： 10.1136/tsaco-2023-001134

PubMed

researchmap

記述言語：英語  

Ruptured cerebral aneurysms that occur in the anterior wall of the internal carotid artery (ICA) are known as blood blister-like aneurysms (BBAs); they have been reported to account for 0.3% to 1% of all ruptured ICA aneurysms. In this report, we describe the treatment of an unusual traumatic BBA (tBBA) with high-flow bypass using a radial artery graft, which resulted in a favorable outcome. A 59-year-old female suffered from an acute epidural hematoma, traumatic subarachnoid hemorrhage, and traumatic carotid-cavernous sinus fistula (tCCF) after being involved in a motor vehicle accident. Her angiography results showed tCCF and a tBBA on the anterior wall of the right ICA. On the fourth day after injury, we found rebleeding from the tBBA and performed an emergency high-flow bypass using a radial artery graft with lesion trapping as a curative procedure for the tCCF and tBBA. Postoperatively, right abducens nerve palsy appeared, but no other neurological symptoms were noted; the patient was thereafter transferred to a rehabilitation hospital 49 days after injury. Traumatic ICA aneurysms commonly occur close to the anterior clinoid process, form within 1 to 2 weeks of injury, and often rupture around 2 weeks after trauma. This case was considered rare as the ICA was likely injured and bleeding at the time of injury, resulting in a form of tBBA; this allowed early detection and appropriate treatment that resulted in a good outcome.

DOI： 10.2176/jns-nmc.2023-0088

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER  

Aim: This study aimed to investigate the relationship between transient return of spontaneous circulation (ROSC) before extracorporeal membrane oxygenation (ECMO) initiation and outcomes in out-of-hospital cardiac arrest (OHCA) patients, who were resuscitated with extracorporeal cardiopul-monary resuscitation (ECPR).Methods: This study was a secondary analysis of the SAVE-J II study, which was a retrospective multicentre registry study involving 36 participating institutions in Japan. We classified patients into two groups according to the presence or absence of transient ROSC before ECMO initiation. Tran-sient ROSC was defined as any palpable pulse of >= 1 min before ECMO initiation. The primary outcome was favourable neurological outcomes (cerebral performance categories 1-2).Results: Of 2,157 patients registered in the SAVE-J II study, 1,501 met the study inclusion criteria; 328 (22%) experienced transient ROSC before ECMO initiation. Patients with transient ROSC had better outcomes than those without ROSC (favourable neurological outcome, 26% vs 12%, P < 0.001; survival to hospital discharge, 46% vs 24%, respectively; P < 0.001). A Kaplan-Meier plot showed better survival in the transient ROSC group (log-rank test, P < 0.001). In multiple logistic analyses, transient ROSC was significantly associated with favourable neurological outcomes and survival (favourable neurological outcomes, adjusted odds ratio, 3.34 [95% confidence interval, 2.35-4.73]; survival, adjusted odds ratio, 3.99 [95% confidence interval, 2.95-5.40]).Conclusions: In OHCA patients resuscitated with ECPR, transient ROSC before ECMO initiation was associated with favourable outcomes. Hence, transient ROSC is a predictor of improved outcomes after ECPR.

DOI： 10.1016/j.resplu.2022.100300

Web of Science

researchmap

担当区分：筆頭著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）  

researchmap

記述言語：英語  

DOI： 10.1089/ham.2022.0074

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本Acute Care Surgery学会  

【目的】高齢者急性腹症に対するopen abdomen management(OAM)の有用性を明らかにする。【方法】2011年4月～2021年3月の間に緊急手術を行った75歳以上の急性腹症について,OAMを行った18例(OAM群)と一期的手術39例[SO(single-stage operation)群]に分け,背景,在院死亡率、合併症率等を比較した。portsmouth-physiological and operative severity score for the enumeration of mortality and morbidity(P-POSSUM)スコアより予測死亡率を算出し,実死亡率と比較した。【結果】OAM群の重症度は高く,在院死亡率(OAM群66.7%,SO群2.6%,p<0.05),合併症率(OAM群55.6%,SO群30.8%)とも高かった。OAM群では予測死亡率70%以上の症例で実死亡率が下回ったが,40～70%の6症例は全例死亡した。【結論】予測死亡率がきわめて高い最重症例にOAMは有用な可能性があるが,適用には症例ごとに熟考を要する。(著者抄録)

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 79-year-old woman collided with a cliff in a passenger automobile. The fire department acknowledged an automated collision notification from the D-Call Net (DCN) at 1 min after the accident and called for doctors by helicopter ("Doctor-Heli" [DH] in Japan) 9 min after the injury. The DH reached the victim 28 min after the injury, and examinations revealed pain in the right side of her chest, tachypnea, and a weak radial artery pulse (indicating shock). The DH arrived at the hospital 49 min after the injury. A thoracic drainage was performed for right-sided tension pneumothorax. She recovered from the shock, but was diagnosed with flail chest and placed on a respirator. She was extubated on postoperative day 6 and transferred to a rehabilitation hospital on postoperative day 57. Due to the DCN, the patient received treatment 15 min earlier than the time taken by the conventional system. Emergency response task forces must develop strategies for connecting DCN warnings to a rapid medical response.

DOI： 10.1272/jnms.JNMS.2023_90-606

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Traumatic brain injury (TBI) is associated with coagulation/fibrinolysis disorders. We retrospectively evaluated 61 TBI cases transported to hospital within 1 h post-injury. Levels of thrombin-antithrombin III complex (TAT), D-dimer, and plasminogen activator inhibitor-1 (PAI-1) were measured on arrival and 3 h, 6 h, 12 h, 1 day, 3 days and 7 days after injury. Multivariate logistic regression analysis was performed to identify prognostic factors for coagulation and fibrinolysis. Plasma TAT levels peaked at admission and decreased until 1 day after injury. Plasma D-dimer levels increased, peaking up to 3 h after injury, and decreasing up to 3 days after injury. Plasma PAI-1 levels increased up to 3 h after injury, the upward trend continuing until 6 h after injury, followed by a decrease until 3 days after injury. TAT, D-dimer, and PAI-1 were elevated in the acute phase of TBI in cases with poor outcome. Multivariate logistic regression analysis showed that D-dimer elevation from admission to 3 h after injury and PAI-1 elevation from 6 h to 1 day after injury were significant negative prognostic indicators. Post-TBI hypercoagulation, fibrinolysis, and fibrinolysis shutdown were activated consecutively. Hyperfibrinolysis immediately after injury and subsequent fibrinolysis shutdown were associated with poor outcome.

DOI： 10.1038/s41598-022-23912-4

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Coagulopathy, a common complication of traumatic brain injury (TBI), is characterized by a hypercoagulable state developing immediately after injury, with hyperfibrinolysis and bleeding tendency peaking 3 h after injury, followed by fibrinolysis shutdown. Reflecting this timeframe, the coagulation factor fibrinogen is first consumed and then degraded after TBI, its concentration rapidly decreasing by 3 h post-TBI. The fibrinolytic marker D-dimer reaches its maximum concentration at the same time. Hyperfibrinolysis in the acute phase of TBI is associated with poor prognosis via hematoma expansion. In the acute phase, the coagulation and fibrinolysis parameters must be monitored to determine the treatment strategy. The combination of D-dimer plasma level at admission and the level of consciousness upon arrival at the hospital can be used to predict the patients who will "talk and deteriorate." Fibrinogen and D-dimer levels should determine case selection and the amount of fresh frozen plasma required for transfusion. Surgery around 3 h after injury, when fibrinolysis and bleeding diathesis peak, should be avoided if possible. In recent years, attempts have been made to estimate the time of injury from the time course of coagulation and fibrinolysis parameter levels, which has been particularly useful in some cases of pediatric abusive head trauma patients.

DOI： 10.2176/jns-nmc.2022-0226

PubMed

researchmap

記述言語：日本語   出版者・発行元：(株)へるす出版  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：NATURE PORTFOLIO  

Heatstroke is a life-threatening event that affects people worldwide. Currently, there are no established tools to predict the outcomes of heatstroke. Although the Sequential Organ Failure Assessment (SOFA) score is a promising tool for judging the severity of critically ill patients. Therefore, in this study, we investigated whether the SOFA score could predict the outcome of patients hospitalized with severe heatstroke, including the classical and exertional types, by using data from a Japanese nationwide multicenter observational registry. We performed retrospective subanalyses of the Japanese Association for Acute Medicine heatstroke registry, 2019. Adults with a SOFA score ≥ 1 hospitalized for heatstroke were analyzed. We analyzed data for 225 patients. Univariate and multivariable analyses showed a significant difference in the SOFA score between non-survivors and survivors in classical and exertional heatstroke cases. The area under the receiver operating characteristic curve were 0.863 (classical) and 0.979 (exertional). The sensitivity and specificity of SOFA scores were 50.0% and 97.5% (classical), 66.7% and 97.5% (exertional), respectively, at a cutoff of 12.5, and 35.0% and 98.8% (classical), 33.3% and 100.0% (exertional), respectively, at a cutoff of 13.5. This study revealed that the SOFA score may predict mortality in patients with heatstroke and might be useful for assessing prognosis.

DOI： 10.1038/s41598-022-20878-1

Web of Science

PubMed

researchmap

記述言語：英語   出版者・発行元：BMC  

Recently, a letter to the editor was published to comment on the 5A score which is the prediction model for accidental hypothermia patients comparing the HOPE score. In this letter, we responded to the comments to clarify the difference between the 5A score and the HOPE score.

DOI： 10.1186/s40560-022-00636-1

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本Acute Care Surgery学会  

researchmap

記述言語：日本語   出版者・発行元：日本Acute Care Surgery学会  

researchmap

記述言語：日本語   出版者・発行元：日本Acute Care Surgery学会  

researchmap

記述言語：日本語   出版者・発行元：(公社)日本医学放射線学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Frontiers Media SA  

Ventilator liberation is one of the most critical decisions in the intensive care unit; however, prediction of extubation failure is difficult, and the proportion thereof remains high. Machine learning can potentially provide a breakthrough in the prediction of extubation success. A total of seven studies on the prediction of extubation success using machine learning have been published. These machine learning models were developed using data from electronic health records, 8–78 features, and algorithms such as artificial neural network, LightGBM, and XGBoost. Sensitivity ranged from 0.64 to 0.96, specificity ranged from 0.73 to 0.85, and area under the receiver operating characteristic curve ranged from 0.70 to 0.98. The features deemed most important included duration of mechanical ventilation, PaO₂, blood urea nitrogen, heart rate, and Glasgow Coma Scale score. Although the studies had limitations, prediction of extubation success by machine learning has the potential to be a powerful tool. Further studies are needed to assess whether machine learning prediction reduces the incidence of extubation failure or prolongs the duration of ventilator use, thereby increasing tracheostomy and ventilator-related complications and mortality.

DOI： 10.3389/fmed.2022.961252

PubMed

researchmap

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： 10.34367/jjcrbd.34.2_101

researchmap

記述言語：日本語   出版者・発行元：(公社)日本医学放射線学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

新型コロナウイルス感染症蔓延下において脳死下臓器提供数が減少しているなかで,脳死判定を目的とした転院搬送の是非に関する議論が始まっている。これをふまえ,全国救命センターにおけるコロナ禍での脳死判定や脳死下臓器移植に関わる現状と問題点を調査した。全国救命センター295施設に質問紙URLを送付し電子的に回収した。調査項目は施設背景,臓器提供の意思決定に関する質問,臓器提供も見据えた患者管理,脳死判定,臓器提供手術の問題点に関する質問,臓器提供を目的とした転院に関する質問とした。220施設より回答を得た(回答率74.6%)。コロナ禍において臓器提供を施行した施設は45施設(20.5%)存在した。臓器提供を行った施設とそうでなかった施設において,休日夜間帯に勤務をしている専門医数に差が見られた(平均3.04人対2.44人)。また,コロナ禍によって臓器提供に関する事項が影響を受けたと回答した施設は全国救命センターの43施設(19.6%)に及び,患者個室管理,家族の面会制限,チームの参集困難など,感染対策による影響と回答した施設がうち39施設(90.7%)に見られた。「脳死下臓器提供」を目的とした転院に関し,他施設に転送したいと回答した施設群(60施設:27%)は,院内連携が手薄く,マンパワーが少なく,また,脳死判定医が少ないこと,脳死判定の費用に関わる経済的問題に要因があると思われた。本研究によりコロナ禍における脳死下臓器提供に関わるハード,ソフト両面の課題が明確になった。とくに施設におけるマンパワー拡充のための施設間連携と経済的支援の拡充が今後の課題であると思われた。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：(公社)日本医学放射線学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC  

BACKGROUND: Automated infrared pupillometry (AIP) and the Neurological Pupil index (NPi) provide an objective means of assessing and trending the pupillary light reflex (PLR) across a broad spectrum of neurological diseases. NPi quantifies the PLR and ranges from 0 to 5; in healthy individuals, the NPi of both eyes is expected to be ≥ 3.0 and symmetric. AIP values demonstrate emerging value as a prognostic tool with predictive properties that could allow practitioners to anticipate neurological deterioration and recovery. The presence of an NPi differential (a difference ≥ 0.7 between the left and right eye) is a potential sign of neurological abnormality. METHODS: We explored NPi differential by considering the modified Rankin Score at discharge (DC mRS) among patients admitted to neuroscience intensive care units (NSICU) of 4 U.S. and 1 Japanese hospitals and for two cohorts of brain injuries: stroke (including subarachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke, and aneurysm, 1,200 total patients) and 185 traumatic brain injury (TBI) patients for a total of more than 54,000 pupillary measurements. RESULTS: Stroke patients with at least 1 occurrence of an NPi differential during their NSICU stay have higher DC mRS scores (3.9) compared to those without an NPi differential (2.7; P < .001). Patients with TBI and at least 1 occurrence of an NPi differential during their NSICU stay have higher discharge modified Rankin Scale scores (4.1) compared to those without an NPi differential (2.9; P < .001). When patients experience both abnormalities, abnormal (NPi < 3.0) and an NPi differential, the latter has an anticipatory relationship with respect to the former (P < .001 for z-score skewness analysis). Finally, our analysis confirmed ≥ 0.7 as the optimal cutoff value for the NPi differential (AUC = 0.71, P < .001). CONCLUSION: The NPi differential is an important factor that clinicians should consider when managing critically ill neurological injured patients admitted to the neurocritical care units. TRIAL REGISTRATION: NCT02804438 , Date of Registration: June 17, 2016.

DOI： 10.1186/s12883-022-02801-3

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(株)へるす出版  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC  

BACKGROUND: The 5A score including five components "Age, Activities of daily living, Arrest, Acidemia and Albumin" was developed as an easy-to-use screening tool for predicting in-hospital mortality among patients with accidental hypothermia. However, the external validity of the 5A score has not yet been evaluated. We aimed to perform an external validation of the 5A score model. METHOD: This secondary analysis of the multicenter, prospective cohort Japanese Association for Acute Medicine-Hypothermia Study (2018-2019), which was conducted at 87 and 89 institutions throughout Japan, collected data from December 2018 to February 2019 and from December 2019 to February 2020. Adult accidental hypothermia patients whose body temperature was 35 °C or less were included in this analysis. The probability of in-hospital mortality was calculated using a logistic regression model of the 5A score. The albumin was not recorded in this database; thus, it was imputed by estimation. Predictions were compared with actual observations to evaluate the calibration of the model. Furthermore, decision-curve analysis was used to evaluate the clinical usefulness. RESULTS: Of the 1363 patients registered in the database, data of 1139 accidental hypothermia patients were included for analysis. The median [interquartile range] age was 79 [68-87] years, and there were 625 men (54.9%) in the study cohort. The predicted probability and actual observation by risk groups produced the following results: low 7% (5.4-8.6), mild 19.1% (17.4-20.8), moderate 33.2% (29.9-36.5), and high 61.9% (55.9-67.9) predicted risks, and the low 12.4% (60/483), mild 17.7% (59/334), moderate 32.6% (63/193), and high 69% (89/129) observed mortality. These results indicated that the model was well calibrated. Decision-curve analysis visually indicated the clinical utility of the 5A score model. CONCLUSION: This study indicated that the 5A score model using estimated albumin value has external validity in a completely different dataset from that used for the 5A model development. The 5A score is potentially helpful to predict the mortality risk and may be one of the valuable information for discussing the treatment strategy with patients and their family members.

DOI： 10.1186/s40560-022-00617-4

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(株)へるす出版  

researchmap

記述言語：日本語   出版者・発行元：(株)へるす出版  

researchmap

記述言語：日本語   出版者・発行元：(株)へるす出版  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Intracranial tumors rarely accompany Down syndrome. Although germ cell tumor and glioma have been reported in Down syndrome, primary central nervous system lymphoma (PCNSL) has not been reported in Down syndrome. We report our experience with a patient with Down syndrome in whom PCNSL was diagnosed. The patient, a 48-year-old man with a diagnosis of Down syndrome, had no history of malignant tumors. The patient visited the hospital with complaints of left hemiparesis and gait disturbance. A thorough examination revealed the brain tumors, and tumor biopsy confirmed the diagnosis of PCNSL. The final pathological diagnosis was diffuse large B-cell lymphoma of the central nervous system. Chemotherapy with rituximab, methotrexate, procarbazine, and vincristine was administered, and whole-brain irradiation was planned in conjunction with chemotherapy. It is unclear whether the chromosomal abnormalities of Down syndrome were involved in the development of PCNSL or not. Further molecular biological analysis may clarify the mechanism of the combination of Down syndrome and PCNSL.

DOI： 10.1272/jnms.JNMS.2023_90-502

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC  

BACKGROUND: The 5A score including five components "Age, Activities of daily living, Arrest, Acidemia and Albumin" was developed as an easy-to-use screening tool for predicting in-hospital mortality among patients with accidental hypothermia. However, the external validity of the 5A score has not yet been evaluated. We aimed to perform an external validation of the 5A score model. METHOD: This secondary analysis of the multicenter, prospective cohort Japanese Association for Acute Medicine-Hypothermia Study (2018-2019), which was conducted at 87 and 89 institutions throughout Japan, collected data from December 2018 to February 2019 and from December 2019 to February 2020. Adult accidental hypothermia patients whose body temperature was 35 °C or less were included in this analysis. The probability of in-hospital mortality was calculated using a logistic regression model of the 5A score. The albumin was not recorded in this database; thus, it was imputed by estimation. Predictions were compared with actual observations to evaluate the calibration of the model. Furthermore, decision-curve analysis was used to evaluate the clinical usefulness. RESULTS: Of the 1363 patients registered in the database, data of 1139 accidental hypothermia patients were included for analysis. The median [interquartile range] age was 79 [68-87] years, and there were 625 men (54.9%) in the study cohort. The predicted probability and actual observation by risk groups produced the following results: low 7% (5.4-8.6), mild 19.1% (17.4-20.8), moderate 33.2% (29.9-36.5), and high 61.9% (55.9-67.9) predicted risks, and the low 12.4% (60/483), mild 17.7% (59/334), moderate 32.6% (63/193), and high 69% (89/129) observed mortality. These results indicated that the model was well calibrated. Decision-curve analysis visually indicated the clinical utility of the 5A score model. CONCLUSION: This study indicated that the 5A score model using estimated albumin value has external validity in a completely different dataset from that used for the 5A model development. The 5A score is potentially helpful to predict the mortality risk and may be one of the valuable information for discussing the treatment strategy with patients and their family members.

DOI： 10.1186/s40560-022-00616-5

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC  

BACKGROUND: The prevalence of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) has been increasing rapidly worldwide. However, guidelines or clinical studies do not provide sufficient data on ECPR practice. The aim of this study was to provide real-world data on ECPR for patients with OHCA, including details of complications. METHODS: We did a retrospective database analysis of observational multicenter cohort study in Japan. Adult patients with OHCA of presumed cardiac etiology who received ECPR between 2013 and 2018 were included. The primary outcome was favorable neurological outcome at hospital discharge, defined as a cerebral performance category of 1 or 2. RESULTS: A total of 1644 patients with OHCA were included in this study. The patient age was 18-93 years (median: 60 years). Shockable rhythm in the initial cardiac rhythm at the scene was 69.4%. The median estimated low flow time was 55 min (interquartile range: 45-66 min). Favorable neurological outcome at hospital discharge was observed in 14.1% of patients, and the rate of survival to hospital discharge was 27.2%. The proportions of favorable neurological outcome at hospital discharge in terms of shockable rhythm, pulseless electrical activity, and asystole were 16.7%, 9.2%, and 3.9%, respectively. Complications were observed during ECPR in 32.7% of patients, and the most common complication was bleeding, with the rates of cannulation site bleeding and other types of hemorrhage at 16.4% and 8.5%, respectively. CONCLUSIONS: In this large cohort, data on the ECPR of 1644 patients with OHCA show that the proportion of favorable neurological outcomes at hospital discharge was 14.1%, survival rate at hospital discharge was 27.2%, and complications were observed during ECPR in 32.7%.

DOI： 10.1186/s13054-022-03998-y

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本臨床救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本臨床救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本臨床救急医学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

BACKGROUND: The coronavirus disease (COVID-19) poses an urgent threat to global public health and is characterized by rapid disease progression even in mild cases. In this study, we investigated whether machine learning can be used to predict which patients will have a deteriorated condition and require oxygenation in asymptomatic or mild cases of COVID-19. METHODS: This single-center, retrospective, observational study included COVID-19 patients admitted to the hospital from February 1, 2020, to May 31, 2020, and who were either asymptomatic or presented with mild symptoms and did not require oxygen support on admission. Data on patient characteristics and vital signs were collected upon admission. We used seven machine learning algorithms, assessed their capability to predict exacerbation, and analyzed important influencing features using the best algorithm. RESULTS: In total, 210 patients were included in the study. Among them, 43 (19%) required oxygen therapy. Of all the models, the logistic regression model had the highest accuracy and precision. Logistic regression analysis showed that the model had an accuracy of 0.900, precision of 0.893, and recall of 0.605. The most important parameter for predictive capability was SpO2, followed by age, respiratory rate, and systolic blood pressure. CONCLUSION: In this study, we developed a machine learning model that can be used as a triage tool by clinicians to detect high-risk patients and disease progression earlier. Prospective validation studies are needed to verify the application of the tool in clinical practice.

DOI： 10.1272/jnms.JNMS.2022_89-210

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

OBJECTIVE: Placing an extracranial-intracranial (EC-IC) high-flow bypass using a radial artery (RA) graft plus internal carotid artery (ICA) trapping or ligation is an option for treating patients expected to be at high risk for complications by direct surgical treatment of the ICA. We focused on the anastomosis between the external carotid artery (ECA) and the RA graft in the cervical region and present adverse events and salvage procedures. METHODS: EC-IC high-flow bypass procedures using an RA graft were performed to treat 87 consecutive patients. The ECA diameter at the midpoint of the planned ECA-RA anastomosis and the non-branched length of the ECA were measured on preoperative angiograms. To study adverse events related to ECA-RA anastomoses, we reviewed the patients' surgical records and intraoperative videos. RESULTS: In 11 patients (12.6%) we encountered adverse events during anastomosis between the ECA and RA. The rate of ECA dissection was significantly higher in males (4/17; 23.5%) than females (3/70; 4.3%) (p = 0.012). Logistic regression analysis revealed that males, individuals with diabetes mellitus, and patients whose non-branching length of the ECA was short (16.1 ± 6.7 mm) were at high risk of ECA problems. We set the cutoff point at 17.5 mm (the area under the ROC curve was 0.72). CONCLUSIONS: Our findings indicate that patients, especially males, treated by extracranial-intracranial high-flow bypass using an RA graft are at increased risk for adverse events when the ECA length at the site of the planned anastomosis is shorter than 17.5 mm.

DOI： 10.1016/j.wneu.2022.04.061

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

Coagulopathy is a common sequela of traumatic brain injury. Consumptive coagulopathy and secondary hyperfibrinolysis are associated with hypercoagulability. In addition, fibrinolytic pathways are hyperactivated as a result of vascular endothelial cell damage in the injured brain. Coagulation and fibrinolytic parameters change dynamically to reflect these pathologies. Fibrinogen is consumed and degraded after injury, with fibrinogen concentrations at their lowest 3-6 h after injury. Hypercoagulability causes increased fibrinolytic activity, and plasma levels of D-dimer increase immediately after traumatic brain injury, reaching a maximum at 3 h. Owing to disseminated intravascular coagulation in the presence of fibrinolysis, the bleeding tendency is highest within the first 3 h after injury, and often a condition called "talk and deteriorate" occurs. In neurointensive care, it is necessary to measure coagulation and fibrinolytic parameters such as fibrinogen and D-dimer routinely to predict and prevent the development of coagulopathy and its negative outcomes. Currently, the only evidence-based treatment for traumatic brain injury with coagulopathy is tranexamic acid in the subset of patients with mild-to-moderate traumatic brain injury. Coagulation and fibrinolytic parameters should be closely monitored, and treatment should be considered on a patient-by-patient basis.

DOI： 10.2176/jns-nmc.2022-0018

Web of Science

PubMed

researchmap

記述言語：英語  

The timing and order of multiple surgeries for patients with multiple thoracic injuries have not been standardized. A 75-year-old man, who was injured because of a closing elevator door, underwent intubation, bilateral chest drain insertion, and massive blood transfusion due to shock and respiratory distress. Computed tomography showed hemopneumothorax with extravasation, tracheobronchial injury, aortic injury, thoracic vertebral anterior dislocation, and multiple rib fractures. He was hospitalized and underwent embolization on the day of admission. Next, veno-venous extracorporeal membrane oxygenation (VV-ECMO) was conducted to address severe respiratory failure. The most crucial aspect of the management was treating the tracheobronchial injury because weaning the patient off the VV-ECMO depended on the success of the repair. Thus, the tracheobronchial repair was performed 7-10 days after injury. A right intrathoracic hematoma removal was performed on the third day and a thoracic endovascular aortic repair on the fifth day. The tracheobronchial repair was performed on the ninth day followed by the posterior thoracic fusion on the 18th day. The patient was successfully weaned off the VV-ECMO and mechanical ventilation on the 24th and 46th days, respectively. Early surgery is not always ideal when managing thoracic trauma cases involving multiple sites. Rather, the treatment should be individualized, and the essential surgical procedures should be timed appropriately.

DOI： 10.1016/j.tcr.2022.100625

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CUREUS INC  

Traumatic brain injury (TBI) is increasingly a major cause of disability across the globe. The current methods of diagnosis are inadequate at classifying patients and prognosis. TBI is a diagnostic and therapeutic challenge. There is no Food and Drug Administration (FDA)-approved treatment for TBI yet. It took about 16 years of preclinical research to develop accurate and objective diagnostic measures for TBI. Two brain-specific protein biomarkers, namely, ubiquitin C-terminal hydrolase-L1 and glial fibrillary acidic protein, have been extensively characterized. Recently, the two biomarkers were approved by the FDA as the first blood-based biomarker, Brain Trauma Indicator™ (BTI™), via the Breakthrough Devices Program. This scoping review presents (i) TBI diagnosis challenges, (ii) the process behind the FDA approval of biomarkers, and (iii) known unknowns in TBI biomarker biology. The current lag in TBI incidence and hospitalization can be reduced if digital biomarkers such as hard fall detection are standardized and used as a mechanism to alert paramedics to an unresponsive trauma patient.

DOI： 10.7759/cureus.23804

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本在宅救急医学会  

わが国における救急車搬送は664万件/年を超え、人口高齢化に相まってますます増加傾向にある。個々の患者に迅速かつ最善の治療を施すのが医師の使命であり、救急診療の場においても常に診療の質を保つことが不可欠である。しかし今、このコロナ禍で学生教育や若手医療者育成はそれに追いついているであろうか?医学生・看護学生は国家試験対策、若手医師・看護師は働き方改革による労働時間制限やコロナ禍による実習中断からon the job trainingによる自己研鑽の場が失われつつある。緊迫した救急現場では、患者救命優先のため、医学生・看護学生や若手医師・看護師は患者に近寄ることもできない。現場では、より効率よく、リアルで、インプレッシブな医学教育手法が求められているのである。われわれは患者やご家族の許可をいただき、熟練した医療スタッフによるよどみない初期診療をvirtual reality(VR)化し、学生授業や若手医師・看護師教育に生かす取り組みを始めている。学生や若手医療者が救急医学のエキスパートスタッフによる診療を繰り返し疑似体験でき、場所や時間を問わず診療手順を体得できる。GuruVR Smart Syncによるマルチモードにより複数の受講生目線を共有することでタイムリーなフィードバックも可能になっている。遠隔による授業展開をすることで、コロナ禍に負けない医療体制を構築するのみならず、教育の地方間格差もなくすことで医師の地域偏在解決などにも貢献できればと思う。「机上の学問」という言葉は従来、実地的でない教育の代名詞としてさげすまれてきた。VR教育ツールがわが国の医療のクオリティを保ち、多くの患者の救命に貢献することで、この言葉の概念を根底から変えることを強く期待している。(著者抄録)

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BAISHIDENG PUBLISHING GROUP INC  

BACKGROUND: Acute portal vein thrombosis (PVT) with bowel necrosis is a fatal condition with a 50%-75% mortality rate. This report describes the successful endovascular treatment (EVT) of two patients with severe PVT. CASE SUMMARY: The first patient was a 22-year-old man who presented with abdominal pain lasting 3 d. The second patient was a 48-year-old man who presented with acute abdominal pain. Following contrast-enhanced computed tomography, both patients were diagnosed with massive PVT extending to the splenic and superior mesenteric veins. Hybrid treatment (simultaneous necrotic bowel resection and EVT) was performed in a hybrid operating room (OR). EVTs, including aspiration thrombectomy, catheter-directed thrombolysis (CDT), and continuous CDT, were performed via the ileocolic vein under laparotomy. The portal veins were patent 4 and 6 mo posttreatment in the 22-year-old and 48-year-old patients, respectively. CONCLUSION: Hybrid necrotic bowel resection and transileocolic EVT performed in a hybrid OR is effective and safe.

DOI： 10.12998/wjcc.v10.i6.1876

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J04260&link_issn=&doc_id=20220307420007&doc_link_id=10.1272%2Fmanms.18.41&url=https%3A%2F%2Fdoi.org%2F10.1272%2Fmanms.18.41&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

researchmap

記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

AIM: Foreign body airway obstruction (FBAO) is a major public health concern worldwide for infants and older adults. This study determines the association between airway obstruction time and neurological outcomes to plan an effective response for patients with FBAO. METHODS: This multicenter retrospective observational study was carried out among patients with life-threatening FBAO in Japan over a period of 4 years. The duration of airway obstruction was calculated from the time of the accident to the time of foreign body removal. The study examined the relationship between airway obstruction time and outcome. The primary outcome was vegetative state or death at hospital discharge. RESULTS: Among 119 patients, 68 were in the category of vegetative state or death. Logistic regression analysis showed that longer airway obstruction time (adjusted odds ratio 1.04; 95% confidence interval 1.01-1.07) was associated with vegetative state or death. When the cut-off value was set at 10, the sensitivity was 0.88, the specificity 0.47, with the area under the curve 0.69. Using the other cut-off value of 4 min, the negative predictive value was 1.00. CONCLUSION: Longer airway obstruction time was associated with vegetative state or death for patients with FBAO. The incidence of vegetative state or death increased when the airway obstruction time exceeded 10 min. Meanwhile, 4 min or less may be set as a target time for foreign body removal in order to prevent vegetative state or death and plan an effective response.

DOI： 10.1002/ams2.741

Web of Science

PubMed

researchmap

その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ams2.741

記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：FRONTIERS MEDIA SA  

Background: Patients with blunt chest trauma have a high mortality rate. The assessment of blush in hepatic and splenic trauma is important for determining the need for emergency hemostatic interventions. However, the frequency and importance of blush in lung contusions are unknown. Therefore, this study aimed to evaluate the frequency of blush in patients with lung contusions and elucidate the relationship between blush and the clinical outcomes of patients with blunt chest trauma. Materials and Methods: In this retrospective observational study, we enrolled patients with an injury severity score of 16 or higher and a chest abbreviated injury scale (AIS) score of 3 or higher who were admitted to the emergency department of Hokkaido University Hospital from January 1, 2003, to December 31, 2016. Blush was defined as active extravasation of an intravascular contrast agent recognized on contrast-enhanced computed tomography. The date of trauma, trauma severity, treatments, and outcomes were obtained from the patients' electronic medical records. Results: During the study period, 83 patients had severe lung contusions and 13 had blush. In-hospital mortality of patients with blush was significantly higher than that of patients without blush (53 vs. 10%, P < 0.001). Patients with blush required thoracic drainage more frequently (100 vs. 71%, P < 0.001) and support through mechanical ventilation more often (100 vs. 64%, P < 0.001) and for a longer duration (median duration, 0 vs. 25 days, P = 0.001) than patients without blush. Conclusions: Our study revealed that blush in lung contusions was not rare and was associated with a high risk of mortality in patients with severe blunt chest trauma. Clinicians should not hesitate to intervene if blush is detected in a lung contusion of a patient with blunt chest trauma.

DOI： 10.3389/fmed.2022.858511

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

AIM: Status epilepticus (SE) is a life-threatening neurological emergency. There is insufficient evidence regarding which antiepileptic therapy is most effective in patients with benzodiazepine-refractory convulsive SE. Therefore, this study aimed to evaluate intravenous phenytoin (PHT) and other intravenous antiepileptic medications for SE. METHODS: We searched PubMed, the Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi for published randomized controlled trials (RCTs) in humans up to August 2019. We compared outcomes between intravenous PHT and other intravenous medications. The important primary composite outcomes were the successful clinical cessation of seizures, mortality, and neurological outcomes at discharge. The reliability of the level of evidence for each outcome was compared using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: A total of 1,103 studies were identified from the databases, and 10 RCTs were included in the analysis. The ratio of successful clinical seizure cessation was significantly lower (risk ratio [RR] 0.89; 95% confidence interval [CI], 0.82-0.97) for patients treated with intravenous PHT than with other medications. When we compared mortality and neurological outcomes at discharge, we observed no significant differences between patients treated with PHT and those treated with other medications. The RRs were 1.07 (95% CI, 0.55-2.08) and 0.91 (95% CI, 0.72-1.15) for mortality and neurological outcomes at discharge, respectively. CONCLUSIONS: Our findings showed that intravenous PHT was significantly inferior to other medications in terms of the cessation of seizures. No significant differences were observed in mortality or neurological outcomes between PHT and other medications.

DOI： 10.1002/ams2.717

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Because choking quickly leads to cardiopulmonary arrest, it is crucial that bystanders remove foreign bodies effectively. Although oral instructions in video calls by dispatchers have improved the quality of cardiopulmonary resuscitation, it is unclear whether video calls improve the quality of first aid for choking infants. Therefore, this simulation study aimed to determine whether video calls with dispatchers improve the quality of first aid for infants with foreign body airway obstruction (FBAO). METHODS: Seventy first-year college students randomly assigned in pairs to communicate by video or audio calls participated in simulated emergency calls for infants with FBAO. Both groups began with oral instruction in voice calls until the transition was made to video calls in the video group. The primary outcome was quality of first aid performance, which was categorized as excellent, acceptable, or poor on the basis of existing guidelines. RESULTS: There were 17 simulations in the video-call groups and 16 in the voice-call groups. After initial oral instruction, the proportion of rescuers that received an evaluation of excellent or acceptable did not differ significantly between the groups (video, 41% vs. voice, 50%; P=0.61); however, evaluations for seven rescuers improved after transitioning to video calls. Ultimately, the proportion receiving a poor evaluation was significantly lower in the video-call group than in the voice-call group (50% vs. 82%, P=0.049). CONCLUSION: Oral instruction communicated by video calls improved the quality of first aid for infants with FBAO.

DOI： 10.1272/jnms.JNMS.2022_89-513

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

AIM: During the coronavirus disease 2019 pandemic, the number of traffic accidents and injured patients was reported to be lower than that before the pandemic. However, little is known regarding the relationship between periods of the state of emergency and the number of patients who met with traffic accidents. METHODS: The numbers of trauma patients and deaths due to traffic accidents in Tokyo and Osaka were collected monthly from the statistics published by the police department. A state of emergency was declared four times in both cities. The number of trauma patients and deaths was compared between the emergency and other periods. RESULTS: The number of monthly patients per 100,000 due to traffic accidents during the state of emergency was significantly lower than that during other periods in Tokyo (16.56 versus 18.20; P = 0.008) and Osaka (24.12 versus 28.79; P = 0.002). However, the monthly number of deaths during the state of emergency was not significantly different compared with those during the other periods in Tokyo (0.08 versus 0.08; P = 0.65) and Osaka (0.10 versus 0.14; P = 0.082). A decrease in the number of trauma patients was observed before the emergency period; however, the reduction rate dropped as the period passed. CONCLUSION: There were significantly fewer trauma patients due to traffic accidents during the state of emergency than during the other periods, with no significant difference in the number of deaths.

DOI： 10.1002/ams2.799

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：FRONTIERS MEDIA SA  

Coagulopathy management is an important strategy for preventing secondary brain damage in patients with traumatic brain injury (TBI). Antithrombin (AT) is a natural anticoagulant that controls coagulation and inflammation pathways. However, the significance of AT activity levels for outcomes in patients with trauma remains unclear. This study aimed to investigate the relationship between AT activity levels and long-term outcomes in patients with TBI; this was a sub-analysis of a prior study that collected blood samples of trauma patients prospectively in a tertiary care center in Kawaguchi City, Japan. We included patients with isolated TBI (iTBI) aged ≥16 years admitted directly to our hospital within 1 h after injury between April 2018 and March 2021. General coagulofibrinolytic and specific molecular biomarkers, including AT, were measured at 1, 3, 6, 12, and 24 h after injury. We analyzed changes in the AT activity levels during the study period and the impact of the AT activity levels on long-term outcomes, the Glasgow Outcome Scale-Extended (GOSE), 6 months after injury. 49 patients were included in this study; 24 had good neurological outcomes (GOSE 6-8), and 25 had poor neurological outcomes (GOSE 1-5). Low AT activity levels were shown within 1 h after injury in patients in the poor GOSE group; this was associated with poor outcomes. Furthermore, AT activity levels 1 h after injury had a strong predictive value for long-term outcomes (area under the receiver operating characteristic curve of 0.871; 95% CI: 0.747-0.994). Multivariate logistic regression analysis with various biomarkers showed that AT was an independent factor of long-term outcome (adjusted odds ratio: 0.873; 95% CI: 0.765-0.996; p=0.043). Another multivariate analysis with severity scores showed that low AT activity levels were associated with poor outcomes (adjusted odds ratio: 0.909; 95% CI: 0.822-1.010; p=0.063). We demonstrated that the AT activity level soon after injury could be a predictor of long-term neurological prognosis in patients with iTBI.

DOI： 10.3389/fimmu.2022.981826

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

AIM: To assess heat stroke and heat exhaustion occurrence and response during the coronavirus disease 2019 pandemic in Japan. METHODS: This retrospective, multicenter, registry-based study describes and compares the characteristics of patients between the months of July and September in 2019 and 2020. Factors affecting heat stroke and heat exhaustion were statistically analyzed. Cramér's V was calculated to determine the effect size for group comparisons. We also investigated the prevalence of mask wearing and details of different cooling methods. RESULTS: No significant differences were observed between 2019 and 2020. In both years, in-hospital mortality rates just exceeded 8%. Individuals >65 years old comprised 50% of cases and non-exertional onset (office work and everyday life) comprised 60%-70%, respectively. The recommendations from the Working Group on Heat Stroke Medicine given during the coronavirus disease pandemic in 2019 had a significant impact on the choice of cooling methods. The percentage of cases, for which intravascular temperature management was performed and cooling blankets were used increased, whereas the percentage of cases in which evaporative plus convective cooling was performed decreased. A total of 49 cases of heat stroke in mask wearing were reported. CONCLUSION: Epidemiological assessments of heat stroke and heat exhaustion did not reveal significant changes between 2019 and 2020. The findings suggest that awareness campaigns regarding heat stroke prevention among the elderly in daily life should be continued in the coronavirus disease 2019 pandemic. In the future, it is also necessary to validate the recommendations of the Working Group on Heatstroke Medicine.

DOI： 10.1002/ams2.731

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：一般社団法人 日本臨床救急医学会  

DOI： 10.11240/jsem.24.830

CiNii Research

researchmap

記述言語：日本語   出版者・発行元：一般社団法人 日本臨床救急医学会  

DOI： 10.11240/jsem.24.828

CiNii Research

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER MASSON, CORP OFF  

PURPOSE: The purpose of this study was to examine the survival benefits of a workflow in which an interventional radiology (IR) team participates in a primary trauma survey on patients with hemodynamically unstable trauma. MATERIALS AND METHODS: A retrospective observational study was conducted between 2012 and 2019 at a single institution. Patients who underwent an IR procedure as the initial hemostasis were assigned to the hemodynamically stable group (HSG) or hemodynamically unstable group (HUG). The primary and secondary outcomes were survival at hospital discharge compared with the probability of survival (Ps) and the time course. RESULTS: A total of 160 patients (100 men, 60 women; median age, 57.5 years [interquartile range (IQR): 31.5-72 years]) with an injury severity score of 24 (IQR: 13.75-34) were included. A total of 125 patients were included in the HSG group and 35 patients in the HUG group. The observational survival rate was significantly greater than the Ps rate by 4.9% (95% confidence interval [CI]: 1.6-8.4%; P = 0.005) in HSG and by 24.6% in HUG (95% CI: 16.9-32.3%; P < 0.001). The observational survival rate was significantly greater than Ps in HUG than in HSG (P < 0.001). The median time to initiate IR procedures and the median procedure time in HUG were 54 min [IQR: 45-66 min] and 48 min [IQR: 30-85 min], respectively; both were significantly shorter than those in the HSG. CONCLUSION: A trauma workflow utilizing an IR team in a primary survey is associated with improved survival of patients with hemodynamically unstable trauma when compared with Ps with a shorter time course.

DOI： 10.1016/j.diii.2021.11.002

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本臨床救急医学会  

2020年4月に開設した当院のCOVID-19専用病棟(重症病床数5)の感染管理区域の準清潔区域において、自律走行型のデリバリーロボット(Relay:NECネッツエスアイ株式会社)による検体および医療資器材の搬送実証実験を行い、その医療従事者の業務負担削減効果、個人防護衣(PPE)使用削減効果について検討した。2021年1月1日〜31日の1ヵ月間、COVID-19病棟においてRelayの試験運用を行い、対象期間中のRelayの搬送回数は688回、1日平均22.2回であった。一方、看護師が物品搬送をする場合、一度の搬送には14.5分(PPE装着とダブルチェックに10分、準清潔区域への移動が1.5分、PPE脱衣に3分)を要していることから、Relayは期間中に合計166時間分の搬送業務を代替したと考えることができた。また、COVID-19病棟で通常使用するPPEはキャップ、マスク(Particulate Respirator Type N95)、シールド、袖付きガウン、手袋で、1回分のコストは約150円であった。したがって期間中、Relayにより688回分のPPEおよび103200円のコスト削減がなされたと考えられた。

researchmap

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J03405&link_issn=&doc_id=20220114570011&doc_link_id=10.11240%2Fjsem.24.828&url=https%3A%2F%2Fdoi.org%2F10.11240%2Fjsem.24.828&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本臨床救急医学会  

救急自動通報(D-Call Net:DCN)による交通事故事例におけるドクターヘリ(DH)実出動事例(2015年〜2021年)について報告した。DCNは事故の工学的情報(速度変化、衝突方向、多重衝突の有無)や安全装置(シートベルト、エアバッグ)の作動情報を変数として算出された「乗員の予測重症外傷受傷確率(重症度)」を根拠に、半自動的にDH要請を行うシステムで、現状では死亡・重症率が5%の閾値を超えた場合にDHの要請がなされる。その結果、期間中の通報数は2360例で、2021年は著増し120件/月を超えており、期間中のDH実出動は11例であった。DCN搭載車は国内登録乗用車の3.3%と少なく、更なる普及が求められるほか、システム改良のための事後検証や情報収集の仕組みが未確立であることも、今後の課題である。

researchmap

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J03405&link_issn=&doc_id=20220114570012&doc_link_id=10.11240%2Fjsem.24.830&url=https%3A%2F%2Fdoi.org%2F10.11240%2Fjsem.24.830&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC  

BACKGROUND: Sepsis is often associated with multiple organ failure; however, changes in brain volume with sepsis are not well understood. We assessed brain atrophy in the acute phase of sepsis using brain computed tomography (CT) scans, and their findings' relationship to risk factors and outcomes. METHODS: Patients with sepsis admitted to an intensive care unit (ICU) and who underwent at least two head CT scans during hospitalization were included (n = 48). The first brain CT scan was routinely performed on admission, and the second and further brain CT scans were obtained whenever prolonged disturbance of consciousness or abnormal neurological findings were observed. Brain volume was estimated using an automatic segmentation method and any changes in brain volume between the two scans were recorded. Patients with a brain volume change < 0% from the first CT scan to the second CT scan were defined as the "brain atrophy group (n = 42)", and those with ≥ 0% were defined as the "no brain atrophy group (n = 6)." Use and duration of mechanical ventilation, length of ICU stay, length of hospital stay, and mortality were compared between the groups. RESULTS: Analysis of all 42 cases in the brain atrophy group showed a significant decrease in brain volume (first CT scan: 1.041 ± 0.123 L vs. second CT scan: 1.002 ± 0.121 L, t (41) = 9.436, p < 0.001). The mean percentage change in brain volume between CT scans in the brain atrophy group was -3.7% over a median of 31 days, which is equivalent to a brain volume of 38.5 cm3. The proportion of cases on mechanical ventilation (95.2% vs. 66.7%; p = 0.02) and median time on mechanical ventilation (28 [IQR 15-57] days vs. 15 [IQR 0-25] days, p = 0.04) were significantly higher in the brain atrophy group than in the no brain atrophy group. CONCLUSIONS: Many ICU patients with severe sepsis who developed prolonged mental status changes and neurological sequelae showed signs of brain atrophy. Patients with rapidly progressive brain atrophy were more likely to have required mechanical ventilation.

DOI： 10.1186/s13054-021-03828-7

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Rupture of a racemose hemangioma causing dilatation and tortuosity of the bronchial artery can result in massive bleeding and respiratory failure. Bronchial artery embolization (BAE) can treat this life-threatening condition, as we show in two cases. The first case was of an 89-year-old female complaining of sudden-onset chest and back pain. Bronchial artery angiography demonstrated a racemose hemangioma with a 2 cm aneurysm. The second case was of a 50-year-old male with hemoptysis and dyspnea, eventually requiring intubation. Bronchial arteriography showed a racemose hemangioma and a bronchial artery-pulmonary arterial fistula. BAE was successfully performed in both cases, with no recurrent hemorrhage. Therapeutic interventions in bronchial artery racemose hemangiomas include lobectomy or segmentectomy, bronchial arterial ligation, and BAE. BAE should be considered as first-line therapy for bleeding racemose hemangiomas of the bronchial artery because of its low risk of adverse effects on respiratory status, minimal invasiveness, and faster patient recovery.

DOI： 10.1272/jnms.JNMS.2022_89-601

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

BackgroundThe epidemiology and treatment of isolated pelvic fracture is not well understood in Japan. This study aimed to evaluate epidemiological trends in isolated pelvic trauma and in-hospital survival rates over 15 years.MethodsThis retrospective cohort study analyzed data from the Japan Trauma Data Bank for 2004-2018. Patients of any age with isolated pelvic fracture were grouped according to time period: 2004-2008 (Phase 1), 2009-2013 (Phase 2), and 2014-2018 (Phase 3). The main outcome was 30-day in-hospital survival rate. The data were analyzed using chi-squared, Kruskal-Wallis, and Mantel-Haenszel trend tests. We analyzed changes in the main outcome over time in a multiple logistic regression analysis fitted with a generalized estimating equation, accounting for the within-cluster association.ResultsIn total, 5348 isolated pelvic fractures occurred during the study period. There was no significant between-phase difference in proportions of patients who underwent resuscitative balloon occlusion of the aorta or external fixation. The proportion of patients who underwent transcatheter arterial embolization increased year by year (p=0.003). There was a significant increase in the survival rate over time (Phase 1, 77%; Phase 2, 86%; and Phase 3, 91%; p<0.001). The 30-day in-hospital mortality rate was significantly lower in Phase 3 than in Phase 1 or Phase 2, even after adjustment for hospital clustering and other confounders (p<0.01).ConclusionsThere was an improvement in the 30-day in-hospital survival rate after isolated pelvic fracture over a 15-year period in Japan.

DOI： 10.1272/jnms.JNMS.2022_89-306

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：日本航空医療学会  

researchmap

記述言語：日本語   出版者・発行元：日本航空医療学会  

researchmap

記述言語：日本語   出版者・発行元：日本Acute Care Surgery学会  

researchmap

記述言語：日本語   出版者・発行元：日本Acute Care Surgery学会  

researchmap

記述言語：日本語   出版者・発行元：日本Acute Care Surgery学会  

researchmap

記述言語：日本語   出版者・発行元：日本航空医療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BENTHAM SCIENCE PUBL  

Traumatic Brain Injury (TBI) is still the worldwide leading cause of mortality and morbidity in young adults. Improved safety measures and advances in critical care have increased chances of surviving a TBI, however, numerous secondary mechanisms contribute to the injury in the weeks and months that follow TBI. The past 4 decades of research have addressed many of the metabolic impairments sufficient to mitigate mortality, however, an enduring secondary mechanism, i.e. neuroinflammation, has been intractable to current therapy. Neuroinflammation is particularly difficult to target with pharmacological agents due to lack of specificity, the blood brain barrier, and an incomplete understanding of the protective and pathologic influences of inflammation in TBI. Recent insights into TBI pathophysiology have established microglial activation as a hallmark of all types of TBI. The inflammatory response to injury is necessary and beneficial while the death of activated microglial is not. This review presents new insights on the therapeutic and maladaptive features of the immune response after TBI with an emphasis on microglial polarization, followed by a discussion of potential targets for pharmacologic and non-pharmacologic treatments. In aggregate, this review presents a rationale for guiding TBI inflammation towards neural repair and regeneration rather than secondary injury and degeneration, which we posit could improve outcomes and reduce lifelong disease burden in TBI survivors.

DOI： 10.2174/1871527319666200918145903

Web of Science

PubMed

researchmap

DOI： 10.7887/jcns.30.71

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC  

BACKGROUND: Frailty has been associated with a risk of adverse outcomes, and mortality in patients with various conditions. However, there have been few studies on whether or not frailty is associated with mortality in patients with accidental hypothermia (AH). In this study, we aim to determine this association in patients with AH using Japan's nationwide registry data. METHODS: The data from the Hypothermia STUDY 2018&19, which included patients of ≥18 years of age with a body temperature of ≤35 °C, were obtained from a multicenter registry for AH conducted at 120 institutions throughout Japan, collected from December 2018 to February 2019 and December 2019 to February 2020. The clinical frailty scale (CFS) score was used to determine the presence and degree of frailty. The primary outcome was the comparison of mortality between the frail and non-frail patient groups. RESULTS: In total, 1363 patients were included in the study, of which 920 were eligible for the analysis. The 920 patients were divided into the frail patient group (N = 221) and non-frail patient group (N = 699). After 30-days of hospitalization, 32.6% of frail patients and 20.6% of non-frail patients had died (p < 0.001). Frail patients had a significantly higher risk of 90-day mortality (Hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.25-2.17; p < 0.001). Based on the Cox proportional hazards analysis using multiple imputation, after adjustment for age, potassium level, lactate level, pH value, sex, CPK level, heart rate, platelet count, location of hypothermia incidence, and rate of tracheal intubation, the HR was 1.69 (95% CI, 1.25-2.29; p < 0.001). CONCLUSIONS: This study showed that frailty was associated with mortality in patients with AH. Preventive interventions for frailty may help to avoid death caused by AH.

DOI： 10.1186/s12877-021-02459-5

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Many invasive procedures are performed in the emergency room (ER), which have potential risks and complications. Due to limitations, especially with respect to size, portable X-ray devices are generally not used during such procedures. However, they have been miniaturized, enabling physicians to capture X-ray images by themselves.. METHODS: We developed a safe, compact, and lightweight X-ray unit and performed five invasive procedures in the ER. In all the procedures, a chest X-ray image was taken to confirm its utility. RESULTS: Case 1 (central venous catheter placement): After needle and guidewire insertion and the placement of the catheter, the location of catheter could be confirmed. Case 2 (chest tube insertion): During the insertion of the chest tube into the pleural space, it was observed that the tip of the thoracic tube was at the appropriate location. Case 3 (percutaneous tracheostomy or cricothyroidotomy): After needle and guidewire insertion, it was visualized that the guidewire was in the right main bronchus and that the tube was inserted into the trachea. Case 4 (resuscitative endovascular aortic balloon of the aorta): The captured image revealed that the catheter was located in zone I before balloon inflation. Case 5 (Sengstaken-Blakemore tube): The image revealed that the balloon was located in the stomach. CONCLUSIONS: The devised portable X-ray unit could contribute medical safety during invasive procedures frequently performed in the ER.

DOI： 10.1272/jnms.JNMS.2022_89-504

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：HUMANA PRESS INC  

BACKGROUND: Hypothermia is neuroprotective in some ischemia-reperfusion injuries. Ischemia-reperfusion injury may occur with traumatic subdural hematoma (SDH). This study aimed to determine whether early induction and maintenance of hypothermia in patients with acute SDH would lead to decreased ischemia-reperfusion injury and improve global neurologic outcome. METHODS: This international, multicenter randomized controlled trial enrolled adult patients with SDH requiring evacuation of hematoma within 6 h of injury. The intervention was controlled temperature management of hypothermia to 35 °C prior to dura opening followed by 33 °C for 48 h compared with normothermia (37 °C). Investigators randomly assigned patients at a 1:1 ratio between hypothermia and normothermia. Blinded evaluators assessed outcome using a 6-month Glasgow Outcome Scale Extended score. Investigators measured circulating glial fibrillary acidic protein and ubiquitin C-terminal hydrolase L1 levels. RESULTS: Independent statisticians performed an interim analysis of 31 patients to assess the predictive probability of success and the Data and Safety Monitoring Board recommended the early termination of the study because of futility. Thirty-two patients, 16 per arm, were analyzed. Favorable 6-month Glasgow Outcome Scale Extended outcomes were not statistically significantly different between hypothermia vs. normothermia groups (6 of 16, 38% vs. 4 of 16, 25%; odds ratio 1.8 [95% confidence interval 0.39 to ∞], p = .35). Plasma levels of glial fibrillary acidic protein (p = .036), but not ubiquitin C-terminal hydrolase L1 (p = .26), were lower in the patients with favorable outcome compared with those with unfavorable outcome, but differences were not identified by temperature group. Adverse events were similar between groups. CONCLUSIONS: This trial of hypothermia after acute SDH evacuation was terminated because of a low predictive probability of meeting the study objectives. There was no statistically significant difference in functional outcome identified between temperature groups.

DOI： 10.1007/s12028-021-01334-w

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

researchmap

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

To avoid preventable trauma death(PTD), initial management, including resuscitation, is crucial in traumatic brain injury(TBI)care. PTD is defined as a case in which the percentage of probability of survival exceeds 50%, but the patient unfortunately dies without appropriate treatment. To diminish cases of PTD, a standardized approach has been established with several training courses and guidelines. However, 20% of all patients with TBI experience PTD. In our study, PTD cases accounted for 26.2% of all cases of so-called "talk and deterioration." Additionally, anti-coagulation/anti-platelet users comprised 26.8% of all PTD cases. Thus, to eliminate PTD, measures against anti-coagulants are important. Moreover, quick decision making regarding treatments preceding the rapid-changing pathophysiology is also essential in TBI care. In addition to securing airway management, providing oxygen support, and stabilizing circulation, timely administration of a neutralizer for anti-coagulative drugs and use of tranexamic acid(a drug for anti-fibrinolysis)is crucial. In this chapter, the pearls of initial TBI management are mentioned, with focus on the "first hour" of treatment.

DOI： 10.11477/mf.1436204475

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AMER ASSOC NEUROLOGICAL SURGEONS  

OBJECTIVE: Coagulopathy is a well-recognized risk factor for poor outcomes in patients with traumatic brain injury (TBI). Differences in the time courses of coagulation and fibrinolytic parameters between pediatric and adult patients with TBI have not been defined. METHODS: Patients with TBI and an Abbreviated Injury Scale of the head score ≥ 3, in whom the prothrombin time (PT)-international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen concentration, and plasma D-dimer levels were measured on arrival and at 3, 6, and 12 hours after injury, were retrospectively analyzed. Propensity score-matched analyses were performed to adjust baseline characteristics between pediatric patients (aged < 16 years) and adult patients (aged ≥ 16 years). RESULTS: A total of 468 patients (46 children and 422 adults) were included. Propensity score matching resulted in a matched cohort of 46 pairs. Higher PT-INR and APTT values at 1 to 12 hours after injury and lower fibrinogen concentrations at 1 to 6 hours after injury were observed in the pediatric group compared with the adult group. Plasma levels of D-dimer were elevated in both groups at 1 to 12 hours after injury, but no significant differences were seen between the groups. Multivariate logistic regression analysis of the initial coagulation and fibrinolytic parameters in the pediatric group revealed no prognostic significance of the coagulation parameter values, but elevation of the fibrinolytic parameter D-dimer was an independent negative prognostic factor. CONCLUSIONS: In the acute phase of TBI, pediatric patients were characterized by prolongation of PT-INR and APTT and lower fibrinogen concentrations compared with adult patients, but these did not correlate with outcome. D-dimer was an independent prognostic outcome factor in terms of the Glasgow Outcome Scale in pediatric patients with TBI.

DOI： 10.3171/2021.5.PEDS21125

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER  

OBJECTIVE: Rebleeding of aneurysmal subarachnoid hemorrhage (aSAH) is one of the significant risk factors for poor clinical outcome. The rebleeding risk is the highest during the acute phase with an approximate rebleeding rate of 9-17% within the first 24 h. Theoretically, general anesthesia can stabilize a patient's vital signs; however, its effectiveness as initial management for preventing post-aSAH rebleeding remains unclear. The purpose of this study was to determine the feasibility and safety of ultra-early general anesthesia induction for reducing the rebleeding rates among patients with aSAH. MATERIALS AND METHODS: We retrospectively evaluated patients with aSAH who were admitted to our department between January 2013 and December 2019. All the patients underwent ultra-early general anesthesia induction as initial management regardless of their severity. We evaluated the rebleeding rate before definitive treatment, factors influencing rebleeding, and general anesthesia complications. RESULTS: We included 191 patients with two-third of them having a poor clinical grade (World Federation of Neurological Society [WFNS] grade IV or V). The median duration from admission to general anesthesia induction was 22 min. Rebleeding before definitive treatment occurred in nine patients (4.7%). There were significant differences in the Glasgow Coma Scale score (p = 0.047), WFNS grade (p = 0.02), and dissecting aneurysm (p <0.001) between the rebleeding and non-rebleeding patients. There were no cases of unsuccessful tracheal intubation or rebleeding during general anesthesia induction. CONCLUSION: Ultra-early general anesthesia induction could be performed safely in patients with aSAH, regardless of the WFNS grade; moreover, it resulted in lower rebleeding rate than that reported in previous epidemiological reports.

DOI： 10.1016/j.jstrokecerebrovasdis.2021.105926

Web of Science

PubMed

researchmap

記述言語：英語   出版者・発行元：AMER ASSOC NEUROLOGICAL SURGEONS  

DOI： 10.3171/2022.5.PEDS22161

Web of Science

researchmap

記述言語：日本語   出版者・発行元：医学図書出版(株)  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CAMBRIDGE UNIV PRESS  

OBJECTIVE: We conducted a systematic review to determine the prevalence and characteristics of earthquake-associated head injuries for better disaster preparedness and management. METHODS: We searched for all publications related to head injuries and earthquakes from 1985 to 2018 in MEDLINE and other major databases. A search was conducted using "earthquakes," "wounds and injuries," and "cranio-cerebral trauma" as a medical subject headings. RESULTS: Included in the analysis were 34 articles. With regard to the commonly occurring injuries, earthquake-related head injury ranks third among patients with earthquake-related injuries. The most common trauma is lower extremity (36.2%) followed by upper extremity (19.9%), head (16.6%), spine (13.1%), chest (11.3%), and abdomen (3.8%). The most common earthquake-related head injury was laceration or contusion (59.1%), while epidural hematoma was the most common among inpatients with intracranial hemorrhage (9.5%) followed by intracerebral hematoma (7.0%), and subdural hematoma (6.8%). Mortality rate was 5.6%. CONCLUSION: Head injuries were found to be a commonly occurring trauma along with extremity injuries. This knowledge is important for determining the demands for neurosurgery and for adequately managing patients, especially in resource-limited conditions.

DOI： 10.1017/dmp.2021.31

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：NATURE RESEARCH  

In this study, we aimed to develop and validate a machine learning-based mortality prediction model for hospitalized heat-related illness patients. After 2393 hospitalized patients were extracted from a multicentered heat-related illness registry in Japan, subjects were divided into the training set for development (n = 1516, data from 2014, 2017-2019) and the test set (n = 877, data from 2020) for validation. Twenty-four variables including characteristics of patients, vital signs, and laboratory test data at hospital arrival were trained as predictor features for machine learning. The outcome was death during hospital stay. In validation, the developed machine learning models (logistic regression, support vector machine, random forest, XGBoost) demonstrated favorable performance for outcome prediction with significantly increased values of the area under the precision-recall curve (AUPR) of 0.415 [95% confidence interval (CI) 0.336-0.494], 0.395 [CI 0.318-0.472], 0.426 [CI 0.346-0.506], and 0.528 [CI 0.442-0.614], respectively, compared to that of the conventional acute physiology and chronic health evaluation (APACHE)-II score of 0.287 [CI 0.222-0.351] as a reference standard. The area under the receiver operating characteristic curve (AUROC) values were also high over 0.92 in all models, although there were no statistical differences compared to APACHE-II. This is the first demonstration of the potential of machine learning-based mortality prediction models for heat-related illnesses.

DOI： 10.1038/s41598-021-88581-1

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本臨床救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本臨床救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本臨床救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本臨床救急医学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND: To evaluate outcomes of endovascular treatment (EVT) using a combination of multiple endovascular techniques for acute lower limb ischemia (ALLI) and to compare outcomes based on vessel type and artery location. METHODS: A total of 95 consecutive patients with ALLI (mean age, 72.0 years; 65 males; 104 lower limbs) who received emergency EVT using a combination of multiple endovascular techniques including thrombolysis, aspiration thrombectomy, stenting, and balloon angioplasty with or without surgical thromboembolectomy, between January 2005 and December 2017 were included. Vessel type was classified into native artery occlusion (native occlusion) and bypass graft occlusion (graft occlusion), including prosthetic and vein graft. Additionally, native arteries were categorized into below-knee occlusion and non-below-knee occlusion. Technical success, perioperative death (POD), ALLI-related death, amputation, amputation-free survival (AFS), and complications were compared according to vessel type (native occlusion vs. graft occlusion) and artery location (below-knee occlusion vs. non-below-knee occlusion). RESULTS: Of all patients with ALLI, 16.8% underwent a single endovascular technique, whereas 83.2% underwent a combination of multiple endovascular techniques. The technicalsuccess, POD, and ALLI-related death rates in the total number of patients were 94.7%, 11.6%, and 4.2%, respectively. A total of 67 patients (75 limbs) and 28 patients (29 limbs) were classified as having native occlusion and graft occlusion (prosthetic, 24 limbs; vein, 5 limbs), respectively. No significant differences in technical success (native occlusion: 92.5% vs. graft occlusion: 100%), POD (14.9% vs. 3.6%), and ALLI-related death (6.0% vs. 0%) were noted between native occlusion and graft occlusion. However, the 30-day AFS rate of native occlusion was significantly lower than that of graft occlusion (75.2% vs. 96.3%, P=0.01). The amputation rate (P=0.03) and AFS rate (P=0.03) of below-knee occlusion were significantly worse for below-knee occlusion patients than for non-below-knee occlusion patients. CONCLUSIONS: EVT using multiple endovascular techniques for ALLI is effective and safe. A combination of multiple endovascular techniques is crucial for successful treatment. However, native occlusion may have a lower AFS rate than graft occlusion, and below-knee occlusion may have a higher risk of amputation than non-below-knee occlusion.

DOI： 10.1016/j.avsg.2021.02.023

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

PURPOSE: Whether intermittent or continuous neuromuscular-blocking agents (NMBAs) would be appropriate during target temperature management (TTM) after cardiac arrest remains unclear. MATERIALS AND METHODS: In this retrospective cohort study, we utilized the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018 and identified patients who received NMBAs during TTM after cardiac arrest on the day of admission. We compared the in-hospital mortality between the propensity-score-matched intermittent and continuous NMBA groups. RESULTS: We identified 5584 eligible patients; 1488 received intermittent NMBAs and 4096 received continuous NMBAs. After propensity score matching, there was no significant difference in the in-hospital mortality between the intermittent and continuous NMBA groups (32.9% vs. 33.1%; odds ratio, 0.98; 95% confidence interval, 0.82-1.18). In subgroup analyses, in-hospital mortality of the continuous NMBA group was significantly higher than that of the intermittent NMBA group in patients aged ≥65 years (p for interaction = 0.021). CONCLUSIONS: This large retrospective study did not suggest that intermittent NMBAs may be inferior to continuous NMBAs in terms of mortality reduction in the overall population receiving TTM for cardiac arrest. However, continuous NMBAs may be inferior to intermittent NMBAs for reducing mortality in elderly patients.

DOI： 10.1016/j.jcrc.2021.01.002

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

BACKGROUND: The incidence of accidental hypothermia (AH) is low, and the length of hospital stay in patients with AH remains poorly understood. The present study explored which factors were related to prolonged hospitalization among patients with AH using Japan's nationwide registry data. METHODS: The data from the Hypothermia STUDY 2018, which included patients ≥18 years old with a body temperature ≤ 35 °C, were obtained from a multicenter registry for AH conducted at 89 institutions throughout Japan, collected from December 1, 2018, to February 28, 2019. The patients were divided into a "short-stay patients" group (within 7 days) and "long-stay patients" group (more than 7 days). A logistic regression analysis after multiple imputation was performed to obtain odds ratios (ORs) for prolonged hospitalization with age, frailty, location, causes underlying the hypothermia, temperature, pH, potassium level, and disseminated intravascular coagulation (DIC) score as independent variables. RESULTS: In total, 656 patients were included in the study, of which 362 were eligible for the analysis. The median length of hospital stay was 17 days. Of the 362 patients, 265 (73.2%) stayed in the hospital for more than 7 days. The factors associated with prolonged hospitalization were frailty (OR, 2.11; 95% confidence interval [CI], 1.09-4.10; p = 0.027), the occurrence of indoor (OR, 3.20; 95% CI, 1.58-6.46; p = 0.001), alcohol intoxication (OR, 0.17; 95% CI, 0.05-0.56; p = 0.004), pH (OR, 0.07; 95% CI, 0.01-0.76; p = 0.029), potassium level (OR, 1.36; 95% CI, 1.00-1.85; p = 0.048), and DIC score (OR, 1.54; 95% CI, 1.13-2.10; p = 0.006). CONCLUSIONS: Frailty, indoor situation, alcohol intoxication, pH value, potassium level, and DIC score were factors contributing to prolonged hospitalization in patients with AH. Preventing frailty may help reduce the length of hospital stay in patients with AH. In addition, measuring the pH value and potassium level by an arterial blood gas analysis at the ED is recommended for the early evaluation of AH.

DOI： 10.1016/j.ajem.2021.03.079

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

BACKGROUND: Coronavirus disease 2019 (COVID-19) and heat-related illness are systemic febrile diseases. These illnesses must be differentiated during a COVID-19 pandemic in summer. However, no studies have compared and distinguished heat-related illness and COVID-19. We compared data from patients with early heat-related illness and those with COVID-19. METHODS: This retrospective observational study included 90 patients with early heat-related illness selected from the Heatstroke STUDY 2017-2019 (nationwide registries of heat-related illness in Japan) and 86 patients with laboratory-confirmed COVID-19 who had fever or fatigue and were admitted to one of two hospitals in Tokyo, Japan. RESULTS: Among vital signs, systolic blood pressure (119 vs. 125 mm Hg, p = 0.02), oxygen saturation (98% vs. 97%, p < 0.001), and body temperature (36.6°C vs. 37.6°C, p<0.001) showed significant between-group differences in the heatstroke and COVID-19 groups, respectively. The numerous intergroup differences in laboratory findings included disparities in white blood cell count (10.8 × 103/μL vs. 5.2 × 103/μL, p<0.001), creatinine (2.2 vs. 0.85 mg/dL, p<0.001), and C-reactive protein (0.2 vs. 2.8 mg/dL, p<0.001), although a logistic regression model achieved an area under the curve (AUC) of 0.966 using these three factors. A Random Forest machine learning model achieved an accuracy, precision, recall, and AUC of 0.908, 0.976, 0.842, and 0.978, respectively. Creatinine was the most important feature of this model. CONCLUSIONS: Acute kidney injury was associated with heat-related illness, which could be essential in distinguishing or evaluating patients with fever in the summer during a COVID-19 pandemic.

DOI： 10.1272/jnms.JNMS.2021_88-107

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

BACKGROUND: Ventilator weaning protocols are commonly implemented for patients receiving mechanical ventilation. However, the rate of extubation failure remains high despite the protocols. This study investigated the usefulness and accuracy of ventilator weaning through machine learning to predict successful extubation. METHODS: We retrospectively evaluated the data of patients who underwent intubation for respiratory failure and received mechanical ventilation in the intensive care unit (ICU). Data on 57 factors including patient demographics, vital signs, laboratory data, and data from ventilator were extracted. Extubation failure was defined as re-intubation within 72 hours of extubation. For supervised learning, the data were labeled requirement of intubation or not. We used three learning algorithms (Random Forest, XGBoost, and LightGBM) to predict successful extubation. We also analyzed important features and evaluated the area under curve (AUC) and prediction metrics. RESULTS: Overall, 13 of the 117 included patients required re-intubation. LightGBM had the highest AUC (0.950), followed by XGBoost (0.946) and Random Forest (0.930). The accuracy, precision, and recall performance were 0.897, 0.910, and 0.909, for Random Forest; 0.910, 0.912, and 0.931 for XGBoost; and 0.927, 0.915, and 0.960 for LightGBM, respectively. The most important feature was the duration of mechanical ventilation followed by the fraction of inspired oxygen, positive end-expiratory pressure, maximum and mean airway pressures, and Glasgow Coma Scale. CONCLUSIONS: Machine learning could predict successful extubation among patients on mechanical ventilation in the ICU. LightGBM has the highest overall performance. The duration of mechanical ventilation was the most important feature in all models.

DOI： 10.1272/jnms.JNMS.2021_88-508

Web of Science

PubMed

researchmap

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

researchmap

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

researchmap

記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本災害医学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

AIM: This study aimed to measure the influence of wearing face masks on individuals' physical status in a hot and humid environment. METHODS: Each participant experienced different physical situations: (i) not wearing a mask (control), (ii) wearing a surgical mask, (iii) wearing a sport mask. An ingestible capsule thermometer was used to measure internal core body temperature during different exercises (standing, walking, and running, each for 20 min) in an artificial weather room with the internal wet-bulb globe temperature set at 28°C. The change in the participants' physical status and urinary liver fatty acid-binding protein (L-FABP) were measured. RESULTS: Six healthy male volunteers were enrolled in the study. In each participant, significant changes were observed in the heart rate and internal core temperatures after increased exercise intensity; however, no significant differences were observed between these parameters and urinary L-FABP among the three intervention groups. CONCLUSION: Mask wearing is not a risk factor for heatstroke during increased exercise intensity.

DOI： 10.1002/ams2.712

Web of Science

PubMed

researchmap

その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ams2.712

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

AIM: This study describes the clinical characteristics and outcomes as well as the prognostic factors of patients with accidental hypothermia (AH) using Japan's nationwide registry data. METHODS: The Hypothermia study 2018 and 2019, which included patients aged 18 years or older with a body temperature of 35°C or less, was a multicenter registry conducted at 87 and 89 institutions throughout Japan, with data collected from December 2018 to February 2019 and December 2019 to February 2020, respectively. RESULTS: In total, 1363 patients were enrolled in the registry, of which 1194 were analyzed in this study. The median (interquartile range) age was 79 (68-87) years, and the median (interquartile range) body temperature at the emergency department was 30.8°C (28.4-33.6°C). Forty-three percent of patients with AH had a mild condition, 35.2% moderate, and 21.9% severe. AH occurred in an indoor setting in 73.4% and was caused by acute medical illness in 49.3% of patients. A total of 101 (8.5%) patients suffered from cardiopulmonary arrest on arrival at the hospital. The overall 30-day mortality rate was 24.5%, the median (interquartile range) intensive care unit stay was 4 (2-7) days, and the median (interquartile range) hospital stay was 13 (4-27) days. In the multivariable logistic analysis, the prognostic factors were age (≥75 years old), male, activities of daily living (needing total assistance), cause of AH (trauma, alcohol), Glasgow Coma Scale score, and potassium level (>5.5 mEq/L). CONCLUSION: The mortality rate of AH was 24.5% in Japan. The prognostic factors developed in this study may be useful for the early prediction, prevention, and awareness of severe AH.

DOI： 10.1002/ams2.694

Web of Science

PubMed

researchmap

その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ams2.694

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

AIM: The coronavirus disease 2019 (COVID-19) pandemic has imposed a heavy burden on emergency medical services (EMS) systems. Therefore, we quantitatively analyzed impacts of COVID-19 on the EMS system in Tokyo. METHODS: In this retrospective observational study, we used publicly available data, including the daily number of newly diagnosed patients with COVID-19, the weekly number of transport difficulties, and the field activity time, from March 2, 2020, to January 25, 2021. Data for the same period in the previous year were used as controls. RESULTS: The total number of EMS calls decreased by 12.7% in 2020 compared with that in 2019. The number of daily transport difficulties significantly increased in 2020 compared with that in 2019 (89 [72-120] vs 57 [49-63]; P < 0.001). Additionally, the field activity time significantly increased in 2020 compared with that in 2019 (22.7 [22.3-23.8] min vs 20.7 [20.6-21.2] min; P < 0.001). Furthermore, the daily number of new patients with COVID-19 was positively correlated with the number of transport difficulties (R = 0.76) and the field activity time on the scene (R = 0.74). With an increase in the number of people infected with COVID-19 by 1,000, the number of daily transport difficulties increased by 86.4. Per 1,000 infected patients per day, the field activity time increased by 3.48 min. CONCLUSION: This study revealed that the increase in the number of patients with COVID-19 indirectly affected the EMS system in Tokyo.

DOI： 10.1002/ams2.709

Web of Science

PubMed

researchmap

その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ams2.709

記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

AIM: This study aimed to clarify whether the lying-flat position from prehospital to emergency department settings more effectively improves neurological outcomes of patients suspected with acute stroke over the sitting-up position. METHODS: We searched PubMed, the Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi for published randomized controlled trials until September 2019. The study population included patients suspected with acute stroke from prehospital to emergency department settings. We compared outcomes between the lying-flat position and sitting-up position groups. The critical outcome was the modified Rankin Scale score at 90 days, and important composite outcomes were 90-day mortality, pneumonia recurrence, and recurrent ischemic stroke. The certainty of evidence of the outcome level was compared using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: In total, 881 studies were identified from the databases, and two randomized controlled trials were included in the analysis. The pooled risk ratio of 90-day modified Rankin Scale score was not statistically significant (risk ratio 0.86; 95% confidence interval [CI] 0.56-1.32) between the lying-flat position and sitting-up position groups. When comparing the 90-day mortality, pneumonia occurrence, and recurrent ischemic stroke, no significant differences were observed between the two groups. Risk ratio was 1.00 (95% CI 0.87-1.14), 0.90 (95% CI 0.74-1.11), and 0.81 (95% CI 0.14-4.64) for 90-day mortality, pneumonia occurrence, and recurrent ischemic stroke, respectively. CONCLUSION: This study suggests that the lying-flat position is not more effective than the sitting-up position in terms of 90-day modified Rankin Scale score in patients suspected with acute stroke.

DOI： 10.1002/ams2.631

Web of Science

PubMed

researchmap

その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ams2.631

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PUBLIC LIBRARY SCIENCE  

Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been determined. The best available evidence supporting active cooling is based on a case series without comparison groups; thus, the effectiveness of this method in improving patient prognoses cannot be appropriately quantified. Therefore, we compared the outcomes of heat stroke patients receiving active cooling with those of patients receiving rehydration-only therapy. This prospective observational multicenter registry-based study of heat stroke and heat exhaustion patients was conducted in Japan from 2010 to 2019. The patients were stratified into the "severe" group or the "mild-to-moderate" group, per clinical findings on admission. After conducting multivariate logistic regression analyses, we compared the prognoses between patients who received "active cooling + rehydration" and patients who received "rehydration only," with in-hospital death as the endpoint. Sex, age, onset situation (i.e., exertional or non-exertional), core body temperature, liver damage, renal dysfunction, and disseminated intravascular coagulation were considered potential covariates. Among those who received active cooling and rehydration-only therapy, the in-hospital mortality rates were 21.5% and 35.5%, respectively, for severe patients (n = 231) and 3.9% and 5.7%, respectively, for mild-to-moderate patients (n = 578). Rehydration-only therapy was associated with a higher in-hospital mortality in patients with severe heat illness (adjusted odds ratio [aOR], 3.29; 95% confidence interval [CI], 1.21-8.90), whereas the cooling methods were not associated with lower in-hospital mortality in patients with mild-to-moderate heat illness (aOR, 2.22; 95% CI, 0.92-5.84). Active cooling was associated with lower in-hospital mortality only in the severe group. Our results indicated that active cooling should be recommended as an adjunct to rehydration-only therapy for patients with severe heat illness.

DOI： 10.1371/journal.pone.0259441

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

BACKGROUND: The diagnosis of nonocclusive mesenteric ischemia (NOMI) is always challenging in critically ill patients. Herein, we aimed to report a case of NOMI associated with a hyperosmolar hyperglycemic state (HHS). A small amount of hepatic portal venous gas (HPVG) triggered the diagnosis of NOMI. CASE PRESENTATION: A 77-year-old man was transferred due to shock and disorder of consciousness. He was diagnosed with an HHS. We suspected intestinal ischemia due to a small amount of HPVG revealed by computed tomography (CT). Peritoneal signs were revealed after treatment for the HHS. Computed tomography was carried out again 5 h after admission, which showed a large amount of HPVG, remarkable bowel dilatation, and pneumatosis intestinalis. We performed an emergency laparotomy and resected the small bowel necrosis resulting from NOMI. CONCLUSION: An HHS can cause NOMI, and the presence of HPVG on CT is an important finding that suggests mesenteric ischemia, even in small amounts.

DOI： 10.1002/ams2.673

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

AIM: Alcohol-related problems, including trauma, are a great burden on global health. Alcohol metabolism in the Japanese population is genetically inferior to other races. This study aimed to evaluate the effects of alcohol use among a Japanese severe blunt trauma cohort. METHODS: This retrospective observational study analyzed the data of trauma patients registered in the Japan Trauma Data Bank between 2004 and 2019. The primary outcome of this study was in-hospital mortality. The lengths of hospital and intensive care unit stay were the secondary outcomes. Propensity score matching was used to adjust the anatomical severity and patient background to reduce the potential alcohol use bias. RESULTS: We analyzed 46,361 patients categorized into nondrinking (n = 37,818) and drinking (n = 8,543) groups. After a 1:1 propensity score matching (n = 8,428, respectively), despite the Glasgow Coma Scale and Revised Trauma Score scores being significantly lower in the drinking group (14 vs. 13 and 7.84 vs. 7.55, P < 0.001, respectively) and intensive care unit length of stay being significantly longer in the drinking group (6 vs. 7 days, P = 0.002), in-hospital mortality was significantly lower in the alcohol group (11.8% vs. 9.0%, P < 0.001) and there were no differences in the duration of hospital stay (19 vs. 19 days, P = 0.848). CONCLUSION: Despite increasing physiological severity on admission, after adjusting for anatomical severity, alcohol consumption could be beneficial in severe blunt trauma patients as regards in-hospital mortality.

DOI： 10.1002/ams2.671

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(株)自然科学社  

【目的】汎発性腹膜炎患者を対象に術後にポリミキシンB固定化繊維カラムによる直接血液灌流(PMX-DHP)を施行し施行時間とカテコラミンインデックス(CAI)の関連を後ろ向きに検討した。【対象】消化管穿孔後の汎発性腹膜炎でPMX-DHPを施行した34例を対象にした。生存群(S群)と非生存群(NS群)に分け平均血圧(mBP)、CAI、SOFA、APACHE IIについて比較した。【結果】PMX-DHP開始前のmBPとCAIは両群で差はなかった(mBP:67.7 vs 62.7 p=0.61、CAI 17 vs 10 p=0.66)。開始24時間時点でmBPに差はなかったが、S群でCAIは有意に低下した(30 vs 5 p=0.02)。またSOFAスコアはS群で低かった(12 vs 10 p=0.04)。PMX-DHPの施行時間が長いほどCAIは低下した(開始前、6時間、24時間時点23 vs 18.5 vs 7、p<0.01)。24時間時点でのCAIの低下と28日死亡予測を検討すると、Cut offを7としたとき、28日生存予測の感度62.8%、特異度100%、area under the curve(AUC)は0.828(95% confident interval 0.683-0.973)であった。【結語】PMX-DHPの長時間施行はカテコラミンの使用量を減らすことが可能である。開始後24時間時点でのCAIは予後予測に有用である可能性がある。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：(公社)日本医学放射線学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：(株)へるす出版  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MDPI  

Stroke is the most prevalent cardiovascular disease worldwide, and is still one of the leading causes of death and disability. Stem cell-based therapy is actively being investigated as a new potential treatment for certain neurological disorders, including stroke. Various types of cells, including bone marrow mononuclear cells, bone marrow mesenchymal stem cells, dental pulp stem cells, neural stem cells, inducible pluripotent stem cells, and genetically modified stem cells have been found to improve neurological outcomes in animal models of stroke, and there are some ongoing clinical trials assessing their efficacy in humans. In this review, we aim to summarize the recent advances in cell-based therapies to treat stroke.

DOI： 10.3390/ijms21186718

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(株)へるす出版  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER IRELAND LTD  

AIM: Assessment of brainstem function plays a key role in predicting the neurological outcome after cardiac arrest. However, the relationship of the two quantitative brainstem assessment methods-automated infrared pupillometry (AIP) and auditory brainstem response (ABR)-with neurological prognoses remains unclear. This study compares the prognostic value of AIP and ABR after cardiopulmonary arrest. METHODS: This retrospective observational study included 124 comatose patients after cardiopulmonary arrest. ABR and AIP measurements were performed simultaneously within 72 h after return of spontaneous circulation. Neurological outcome was assessed at discharge by estimating the cerebral performance category (CPC) score; favourable neurological outcome (CPC score, 1-2) or poor neurological outcome (CPC score, 3-5). The correlation of each AIP parameter and ABR I-V wave latency was tested using Pearson's product moment correlation coefficient, and the prognostic value was compared using the area under the receiver operating characteristics curve (AUC). RESULTS: Pupillary light reflex (PLR) was not detected in 69 patients, and ABR wave V was not detected in 47 patients. All these patients had poor neurological outcome. Among those whose PLR and ABR could be measured, each AIP parameter had a tendency to be correlated with ABR I-V wave latency. Pupil constriction velocity provided the greatest AUC (0.819), with 81% sensitivity and 77% specificity. ABR I-V wave latency provided extremely low AUC (0.560). CONCLUSIONS: Although AIP and ABR were correlated, the AIP measures were superior in predicting the neurological outcome after cardiac arrest as compared with the ABR measures.

DOI： 10.1016/j.resuscitation.2020.06.002

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(株)へるす出版  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

播種性アスペルギルスによる壊死性筋膜炎は,これまで生存例は報告されていない。今回,後腹膜膿瘍から大腿部壊死性筋膜炎に及んだ播種性アスペルギルス症の救命例を報告する。68歳の男性。Wegener肉芽腫症に対し,近医でprednisolone,azathioprine内服加療中であったが,右大腿壊死性筋膜炎が疑われ,当院に転院となった。腹部CTでは,右後腹膜から大腿部にガスを伴う膿瘍形成があり,早急な壊死組織の除去のため右股関節離断術を行った。翌日2nd look surgeryを行ったところ,後腹膜に腸管内容物を疑う液体流出を認めた。開腹すると,上行結腸に多数の穿孔を認め,これが原因であると考えた。創部や喀痰からAspergillusfumigatusが同定され,播種性アスペルギルス症と診断した。抗菌薬CFPMと抗真菌薬L-AMB,MCFG併用で加療。計7回の創部デブリードマンを行い,第60病日に右骨盤半切除術を施行した。第102病日に創閉鎖が完了。抗真菌薬をVCZ内服に変更し,筆談可能な状態で療養型病院へ転院した。アスペルギルスによる壊死性筋膜炎は生存報告がなく,本症例が初の報告例である。徹底的な壊死組織の除去と長期間の抗真菌薬投与が奏功したと考えた。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：日本シミュレーション医療教育学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

Fever and hyperthermia are the main symptoms of COVID-19 and heatstroke, it is difficult to distinguish them. We came to think that there is a need to discuss safe prevention and medical treatment for heatstroke. In view of the above issues, the Japanese Association for Acute Medicine "Committee on Heatstroke and Hypothermia" established a "Working group on heatstroke medical care given the COVID-19 epidemic" jointly with the Japanese Society for Emergency Medicine that focuses on emergency medical personnel including paramedics and nurses, the Japanese Association for Infectious Diseases, an academic society of infectious disease, and the Japanese Respiratory Society, an academic organization on respiratory diseases. The precautions for prevention of heatstroke this summer during the coronavirus epidemic was summarized in "Proposals on heatstroke prevention based on the COVID-19 epidemic" as follows and was issued on June 1, 2020. Based on the above, we have determined that guidance in clinical practice is necessary not only from the viewpoint of heatstroke prevention, but also from the viewpoint of medical treatment. As such, we have created this guidance in the form of supplementary recommendation.

DOI： 10.1002/ams2.560

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MDPI  

Coagulopathy and older age are common and well-recognized risk factors for poorer outcomes in traumatic brain injury (TBI) patients; however, the relationships between coagulopathy and age remain unclear. We hypothesized that coagulation/fibrinolytic abnormalities are more pronounced in older patients and may be a factor in poorer outcomes. We retrospectively evaluated severe TBI cases in which fibrinogen and D-dimer were measured on arrival and 3-6 h after injury. Propensity score-matched analyses were performed to adjust baseline characteristics between older patients (the "elderly group," aged ≥75 y) and younger patients (the "non-elderly group," aged 16-74 y). A total of 1294 cases (elderly group: 395, non-elderly group: 899) were assessed, and propensity score matching created a matched cohort of 324 pairs. Fibrinogen on admission, the degree of reduction in fibrinogen between admission and 3-6 h post-injury, and D-dimer levels between admission and 3-6 h post-injury were significantly more abnormal in the elderly group than in the non-elderly group. On multivariate logistic regression analysis, independent risk factors for poor prognosis included low fibrinogen and high D-dimer levels on admission. Posttraumatic coagulation and fibrinolytic abnormalities are more severe in older patients, and fibrinogen and D-dimer abnormalities are negative predictive factors.

DOI： 10.3390/ijms21165613

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：東日本整形災害外科学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本臨床救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本インターベンショナルラジオロジー学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本臨床救急医学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMJ PUBLISHING GROUP  

INTRODUCTION: Foreign body airway obstruction (FBAO) is a major public health issue worldwide. In 2017, there were more than 5000 fatal choking cases in the USA alone, and it was the fourth leading cause of preventable injury-related death in the home and community. In Japan, FBAO is the leading cause of accidental death and with almost 9000 fatalities annually. However, research on FBAO is limited, particularly on the impact of a foreign body (FB) removal manoeuvres by bystanders. The primary objective of this study is to determine the impact of bystander FB removal manoeuvres on 1 month neurological outcome. Our secondary objectives include (1) evaluating the efficacy of a variety of FB removal manoeuvres; (2) identifying risk factors for unsuccessful removal and (3) evaluating the impact of time intervals from incidents of FBAO to FB removal on neurological outcome. METHODS AND ANALYSIS: We will conduct a nationwide multi-centre prospective cohort study of patients with FBAO who present to approximately 100 emergency departments in both urban and rural areas in Japan. Research personnel at each participating site will collect variables including patient demographics, type of FB and prehospital variables, such as bystander FB removal manoeuvres, medical interventions by prehospital personnel, advanced airway management and diagnostic findings. Our primary outcome is 1 month favourable neurological outcome defined as cerebral performance category 1 or 2. Our secondary outcomes include success of FB removal manoeuvres and complications from the manoeuvres. We hypothesise that bystander FB removal manoeuvres improve patient survival with a favourable neurological outcome. ETHICS AND DISSEMINATION: This study received research ethics approval from Nippon Medical School Hospital (B-2019-019). Research ethics approval will be obtained from all participating sites before entering patients into the registry. The study was registered at the University Hospital Medical Information Network (UMIN) Clinical Trials Registry. TRIAL REGISTRATION NUMBER: UMIN 000039907.

DOI： 10.1136/bmjopen-2020-039689

Web of Science

PubMed

researchmap

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

researchmap

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

BACKGROUND: Due to aging of the Japanese population, traumatic brain injuries (TBI) in elderly individuals have increased. However, the effectiveness and prognosis of intensive treatment in geriatric TBI have not yet been determined. Thus, we analyzed the prognostic factors of intensive and aggressive treatments using nationwide data from Japan Neurotrauma Data Bank (JNTDB) projects. METHODS: We analyzed 1,879 geriatric TBI cases (≥65 years old) registered in four JNTDB projects, Project 1998 (P1998) to Project 2015 (P2015). Clinical features, aggressive treatment usage, and 6-month outcomes on the Glasgow Outcome Scale (GOS) were compared among study projects. Logistic regression was performed to clarify prognostic factors in aggressively-treated patients. RESULTS: The percentage of geriatric TBI cases significantly increased across time (P1998: 30.1%, Project 2004 (P2004) : 34.6%, Project 2009 (P2009) : 43.9%, P2015: 53.6%, p<0.0001). Aggressive treatment usage also significantly increased, from 67.0% in P1998 to 69.3% in P2015 (p<0.0001). Less invasive methods, such as trepanation and normothermic targeted temperature management, were more often chosen for geriatric patients. These efforts resulted in a significant decrease in the 6-month mortality rate, from 76.2% in P1998 to 63.1% in P2015 (p=0.0003), although the percentage of severely disabled patients increased, from 8.9% in P1998 to 11.1% in P2015 (p = 0.0003). Intraventricular hemorrhage was the most unfavorable prognostic factor for the 6-month outcome (OR 3.79, 95% CI 1.78-8.06, p<0.0001). CONCLUSIONS: Less invasive treatments reduce mortality in geriatric TBI but do not improve functional outcomes. The patients' age does not seem to be the strongest prognostic factor; thus, physicians should not adhere to only age.

DOI： 10.1272/jnms.JNMS.2021_88-404

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER  

A 74-year-old male was referred to our critical care department for refractory severe watery diarrhea with advanced leukocytosis (over 70,000/μl) after multiple administrations of eradication therapy against Helicobacter pylori (HP). He was diagnosed as having fulminant colitis due to Clostridioides difficile after antimicrobial eradication therapy. He was given intravenous metronidazole and oral vancomycin. He also received supportive therapy including continuous hemodiafiltration for severe metabolic acidosis. However, despite emergency open sigmoidectomy, he died. The C. difficile isolate recovered was PCR-ribotype 002, which was positive for toxins A and B but negative for binary toxin. HP eradication therapy for prevention of chronic gastritis and stomach cancer is now in widespread use. Although such secondary severe complications are rare, we consider it to be necessary to pay sufficient attention when administering HP eradication therapy.

DOI： 10.1016/j.jiac.2019.10.021

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

Status epilepticus (SE) is a life-threatening medical and neurological emergency. Prompt recognition and treatment are essential to stop the seizure and improve patient outcomes. To elucidate which benzodiazepine should be used as the first-line treatment, a systemic search of the PubMed, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi databases was carried out to identify randomized controlled trials (RCTs) comparing i.v. administration of lorazepam and diazepam used for adult SE. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Only two RCTs were finally analyzed among 2182 papers extracted. The SE definitions, inclusion criteria, and doses of the drugs differed in the two studies. Of 204 patients included, 103 and 101 patients were allocated to the lorazepam and diazepam groups, respectively. The pooled risk ratio (RR) and confidence interval (CI) for lorazepam treatment on seizure cessation (two RCTs, n = 204) showed a significantly superior effect of lorazepam over diazepam (RR, 1.24; 95% CI, 1.03-1.49). No statistically significant relationship was found for mortality (two RCTs, n = 204) (RR 0.43; 95% CI, 0.43-6.90), poor neurological outcome (one RCT, n = 134) (RR, 1.10; 95% CI, 0.59-2.04), hypotension (one RCT, n = 70) (RR, 2.68; 95% CI, 0.11-63.61), and respiratory depression (two RCTs, n = 204) (RR, 1.07; 95% CI, 0.48-2.48). The certainty of the evidence was rated as very low. The results of this meta-analysis of RCTs showed that i.v. lorazepam was better than i.v. diazepam for the cessation of adult SE.

DOI： 10.1002/ams2.582

Web of Science

PubMed

researchmap

その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ams2.582

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PUBLIC LIBRARY SCIENCE  

We aimed to determine the characteristics of quantitative pupillary response parameters other than amplitude of pupillary light reflex (PLR) early after return of spontaneous circulation (ROSC) and their implications for predicting neurological outcomes early after cardiac arrest (CA). Fifty adults resuscitated after non-traumatic out-of-hospital CA from four emergency hospitals were enrolled. Pupil diameters, PLR, constriction velocity (CV), maximum CV (MCV), dilation velocity (DV), latency of constriction, and Neurological Pupil index (NPi) were quantitatively measured at 0, 6, 12, 24, 48, and 72 h post-ROSC using an automated pupillometer. Change over time of each parameter was compared between favorable (Cerebral Performance Category [CPC] 1 or 2) and unfavorable neurological outcome (CPC 3-5) groups. Prognostic values of 90-day favorable outcome by these parameters and when combined with clinical predictors (witness status, bystander cardiopulmonary resuscitation, initial shockable rhythm, implementation of target temperature management) were tested. Thirteen patients achieved favorable outcome. CV, MCV, DV (P < 0.001), and NPi (P = 0.005) were consistently greater in the favorable group than in the unfavorable outcome group. Change over time was not statistically different between the groups in all parameters. CV, MCV, DV (ρ = 0.96 to 0.97, P < 0.001, respectively), and NPi (ρ = 0.65, P < 0.001) positively correlated with PLR. The prognostic value of 0-hour CV (area under the curve, AUC [95% confidence interval]: 0.92 [0.80-1.00]), DV (0.84 [0.68-0.99]), and NPi (0.88 [0.74-1.00]) was equivalent to that of PLR (0.84 [0.69-0.98]). Prognostic values improved to AUC of 0.95-0.96 when 0-hour PLR, CV, DV, or NPi was combined with clinical predictors. The 0-hour CV, MCV, and NPi showed equivalent prognostic values to PLR alone/in combination with clinical predictors. Using PLR among several quantitative pupillary response parameters for early neurological prognostication of post-CA patients is a simple and effective strategy.

DOI： 10.1371/journal.pone.0228224

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC  

Background: Intracranial pressure control has long been recognized as an important requirement for patients with severe traumatic brain injury. Hypertonic saline has drawn attention as an alternative to mannitol in this setting. The aim of this study was to assess the effects of hypertonic saline versus mannitol on clinical outcomes in patients with traumatic brain injury in prehospital, emergency department, and intensive care unit settings by systematically reviewing the literature and synthesizing the evidence from randomized controlled trials. Methods: We searched the MEDLINE database, the Cochrane Central Register of Controlled Trials, and the Igaku Chuo Zasshi (ICHUSHI) Web database with no date restrictions. We selected randomized controlled trials in which the clinical outcomes of adult patients with traumatic brain injury were compared between hypertonic saline and mannitol strategies. Two investigators independently screened the search results and conducted the data extraction. The primary outcome was all-cause mortality. The secondary outcomes were 90-day and 180-day mortality, good neurological outcomes, reduction in intracranial pressure, and serum sodium level. Random effects estimators with weights calculated by the inverse variance method were used to determine the pooled risk ratios. Results: A total of 125 patients from four randomized trials were included, and all the studies were conducted in the intensive care unit. Among 105 patients from three trials that evaluated the primary outcome, 50 patients were assigned to the hypertonic saline group and 55 patients were assigned to the mannitol group. During the observation period, death was observed for 16 patients in the hypertonic saline group (32.0%) and 21 patients in the mannitol group (38.2%). The risks were not significant between the two infusion strategies (pooled risk ratio, 0.82; 95% confidence interval, 0.49-1.37). There were also no significant differences between the two groups in the other secondary outcomes. However, the certainty of the evidence was rated very low for all outcomes. Conclusions: Our findings revealed no significant difference in the all-cause mortality rates between patients receiving hypertonic saline or mannitol to control intracranial pressure. Further investigation is warranted because we only included a limited number of studies.

DOI： 10.1186/s40560-020-00476-x

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC  

Background: The exacerbation of intracranial bleeding is critical in traumatic brain injury (TBI) patients. Tranexamic acid (TXA) has been used to improve outcomes in TBI patient. However, the effectiveness of TXA treatment remains unclear. This study aimed to assess the effect of administration of TXA on clinical outcomes in patients with TBI by systematically reviewing the literature and synthesizing evidence of randomized controlled trials (RCTs). Methods: MEDLINE, the Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi (ICHUSHI) Web were searched. Selection criteria included randomized controlled trials with clinical outcomes of adult TBI patients administered TXA or placebo within 24 h after admission. Two investigators independently screened citations and conducted data extraction. The primary "critical" outcome was all-cause mortality. The secondary "important" outcomes were good neurological outcome rates, enlargement of bleeding, incidence of ischemia, and hemorrhagic intracranial complications. Random effect estimators with weights calculated by the inverse variance method were used to report risk ratios (RRs). Results: A total of 640 records were screened. Seven studies were included for quantitative analysis. Of 10,044 patients from seven of the included studies, 5076 were randomly assigned to the TXA treatment group, and 4968 were assigned to placebo. In the TXA treatment group, 914 patients (18.0%) died, while 961 patients (19.3%) died in the placebo group. There was no significant difference between groups (RR, 0.93; 95% confidence interval, 0.86-1.01). No significant differences between the groups in other important outcomes were also observed. Conclusions: TXA treatment demonstrated a tendency to reduce head trauma-related deaths in the TBI population, with no significant incidence of thromboembolic events. TXA treatment may therefore be suggested in the initial TBI care.

DOI： 10.1186/s40560-020-00460-5

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

AIM: The mortality rates among elderly patients with open abdomen (OA) are high, and pre-existing comorbidities could affect the outcomes. However, long-term prognosis remains uncertain. We examined long-term outcomes in elderly patients with OA, focusing on physical functional status. METHODS: We undertook a retrospective cohort study between 2007 and 2017 at a single institution. Patients with OA who were aged ≥65 years were categorized into two groups: "good preoperative functional status" group (GFG) and "poor preoperative functional status" group (PFG). The GFG was defined as Eastern Cooperative Oncology Group/World Health Organization performance status (PS) 0-1, whereas PFG was defined as PS 2-4. The primary outcomes were survival and PS 2 years following the initial surgery. RESULTS: Of the 53 participants, 38 and 15 were assigned to the GFG and PFG, respectively. The PFG (median age, 81 years) was older than the GFG (median age, 75.5 years; P = 0.040). The 2-year survival rate was 39.5% in GFG and 6.7% in PFG, and Kaplan-Meier analysis showed significant difference (P = 0.022). Among all patients, the PS at 2 years was worse than that at discharge (P = 0.007). Preoperative PS was correlated with 2-year survival (P = 0.003), whereas age and pre-existing comorbidities were not. CONCLUSION: The long-term outcomes of elderly patients with OA are affected by the preoperative physical functional status. Functional status deteriorates in a time-dependent manner. Therefore, surgery requiring OA must be carefully considered for elderly patients with PS 2 or higher.

DOI： 10.1002/ams2.602

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

BACKGROUND: It is difficult to diagnose Bickerstaff's brainstem encephalitis (BBE) in the acute phase, and emergency physicians could diagnose BBE as an unknown cause of consciousness disturbance. CASE PRESENTATION: A 75-year-old woman presented with dizziness and weakness in both arms 1 week after an upper respiratory infection. She experienced gradual worsening of consciousness, had dilated pupils and no light reflex. She was suspected of brainstem dysfunction at the upper part of the brainstem; however, there were not significant findings on magnetic resonance imaging, cerebrospinal fluid, or electroencephalography. The auditory brainstem response demonstrated a low voltage, but there was no prolonged latency. At a later date, she was diagnosed with BBE based on serum immunoglobulin G anti-GQ1b antibody. She was discharged home without any neurological sequelae. CONCLUSION: It is necessary to analyze serum immunoglobulin G anti-GQ1b antibodies to diagnose BBE. Auditory brainstem response would be helpful in detecting lesions and predicting functional recovery.

DOI： 10.1002/ams2.517

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

AIM: Heat-related illness is common, but its epidemiology and pathological mechanism remain unclear. The aim of this study was to report current clinical characteristics, prognostic factors, and outcomes of heat-related illness in Japan. METHODS: We undertook a prospective multicenter observational study in Japan. Only hospitalized patients with heat-related illness were enrolled from 1 July to 30 September 2017 and 1 July to 30 September 2018. RESULTS: A total of 763 patients were enrolled in the study. Median age was 68 years (interquartile range, 49-82 years) and median body temperature on admission was 38.2°C (interquartile range, 36.8-39.8°C). Non-exertional cause was 56.9% and exertional cause was 40.0%. The hospital mortality was 4.6%. The median Japanese Association for Acute Medicine disseminated intravascular coagulation (JAAM DIC), Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores on admission were 1 (0-2), 4 (2-6), and 13 (8-22), respectively. To predict hospital mortality, areas under the receiver operating characteristic curves were 0.776 (JAAM DIC score), 0.825 (SOFA), and 0.878 (APACHE II). There were 632 cases defined as heatstroke by JAAM heat-related illness criteria, 73 cases diagnosed as having DIC. A total of 16.6% patients had poor neurological outcome (modified Rankin Scale ≥ 4) at hospital discharge. In the multivariate analysis, Glasgow Coma Scale and platelets were independent predictors of mortality. Type of heatstroke, Glasgow Coma Scale, and platelets were independent predictors of poor neurological outcome. Body temperature was not associated with mortality or poor neurological outcome. CONCLUSIONS: In this study, hospital mortality of heat-related illness was <5%, one-sixth of the patients had poor neurological outcome. The APACHE II, SOFA, and JAAM DIC scores predicted hospital mortality. Body temperature was not associated with mortality or poor neurological outcome.

DOI： 10.1002/ams2.516

Web of Science

PubMed

researchmap

記述言語：英語   出版者・発行元：SPRINGER WIEN  

DOI： 10.1007/s00701-019-04078-x

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MDPI  

BACKGROUND: This study aims to compare the Bouchama heatstroke (B-HS) and Japanese Association for Acute Medicine heatstroke (JAAM-HS) criteria with regard to the diagnosis and prediction of mortality and neurological status of heatstroke patients. METHODS: This multicenter observational study recruited eligible patients from the emergency departments of 110 major hospitals in Japan from 1 July to 30 September, 2014. RESULTS: A total of 317 patients (median age, 65 years; interquartile range, 39-80 years) were included and divided into the B-HS, JAAM-HS, and non-HS groups, with each group consisting of 97, 302, and 15 patients, respectively. The JAAM-HS (1.0; 95% confidence interval [CI], 0.87-1.0) and B-HS (0.29; 95% CI, 0.14-0.49) criteria showed high and low sensitivity to mortality, respectively. Similarly, the JAAM-HS (1.0; 95% CI, 0.93-1.0) and B-HS (0.35; 95% CI, 0.23-0.49) criteria showed high and low sensitivity to poor neurological status, respectively. Meanwhile, the sequential organ failure assessment (SOFA) scores demonstrated good accuracy in predicting mortality among heat-related illness (HRI) patients. However, both JAAM-HS and B-HS criteria could not predict in-hospital mortality. The AUC of the SOFA score for mortality was 0.83 (day 3) among the HRI patients. The patients' neurological status was difficult to predict using the JAAM-HS and B-HS criteria. Concurrently, the total bilirubin level could relatively predict the central nervous system function at discharge. CONCLUSIONS: The JAAM-HS criteria showed high sensitivity to mortality and could include all HRI patients who died. The JAAM-HS criterion was considered a useful tool for judgement of admission at ED. Further investigations are necessary to determine the accuracy of both B-HS and JAAM-HS criteria in predicting mortality and neurological status at discharge.

DOI： 10.3390/ijerph16183433

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER WIEN  

BACKGROUND: The association between traumatic brain injury (TBI) and coagulopathy is well established. While coagulopathy prophylaxis in TBI involves replenishing coagulation factors with fresh frozen plasma (FFP), its effectiveness is controversial. We investigated the relationship between plasma fibrinogen concentration 3 h after initiating FFP transfusion and outcomes and evaluated the correlation with D-dimer levels at admission. METHODS: We retrospectively examined data from 380 patients with severe isolated TBI with blood samples collected a maximum of 1 h following injury. Plasma fibrinogen and D-dimer concentrations were obtained at admission, and plasma fibrinogen concentration was again assessed 3-4 h following injury. The patients were divided into two groups based on whether or not they received FFP transfusion. Patients were also divided into subgroups according their fibrinogen level: ≥ 150 mg/dL (high-fibrinogen subgroup) or < 150 mg/dL (low-fibrinogen subgroup) 3 h after injury. Demographic, clinical, radiological and laboratory data were compared between these subgroups. RESULTS: Glasgow Outcome Scale (GOS) scores at discharge and 3 months after injury were significantly lower in the FFP transfusion group than in the FFP non-transfusion group. Among patients who received FFP, GOS scores at discharge and 3 months after injury were significantly higher in the high-fibrinogen subgroup than in the low-fibrinogen subgroup. Elevated admission D-dimer predicted subsequent fibrinogen decrease. CONCLUSIONS: In FFP transfusion, fibrinogen level ≥ 150 mg/dL 3 h after injury was associated with better outcomes in TBI patients. Assessing the admission D-dimer and tracking the fibrinogen are crucial for optimal coagulopathy prophylaxis in TBI patients.

DOI： 10.1007/s00701-019-04010-3

Web of Science

PubMed

researchmap

記述言語：英語   出版者・発行元：OXFORD UNIV PRESS INC  

Web of Science

researchmap

記述言語：英語  

Web of Science

researchmap

記述言語：英語  

Web of Science

researchmap

記述言語：日本語   出版者・発行元：(株)メディカ出版  

CiNii Books

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：FRONTIERS MEDIA SA  

Human neural stem cells (hNSCs) transplantation in several brain injury models has established their therapeutic potential. However, the feasibility of hNSCs transplantation is still not clear for acute subdural hematoma (ASDH) brain injury that needs external decompression. Thus, the aim of this pilot study was to test feasibility using a rat ASDH decompression model with two clinically relevant transplantation methods. Two different methods, in situ stereotactic injection and hNSC-embedded matrix seating on the brain surface, were attempted. Athymic rats were randomized to uninjured or ASDH groups (F344/NJcl-rnu/rnu, n = 7-10/group). Animals in injury group were subjected to ASDH, and received decompressive craniectomy and 1-week after decompression surgery were transplanted with green fluorescent protein (GFP)-transduced hNSCs using one of two approaches. Histopathological examinations at 4 and 8 weeks showed that the GFP-positive hNSCs survived in injured brain tissue, extended neurite-like projections resembling neural dendrites. The in situ transplantation group had greater engraftment of hNSCs than matrix embedding approach. Immunohistochemistry with doublecortin, NeuN, and GFAP at 8 weeks after transplantation showed that transplanted hNSCs remained as immature neurons and did not differentiate toward to glial cell lines. Motor function was assessed with rotarod, compared to control group (n = 10). The latency to fall from the rotarod in hNSC in situ transplanted rats was significantly higher than in control rats (median, 113 s in hNSC vs. 69 s in control, P = 0.02). This study first demonstrates the robust engraftment of in situ transplanted hNSCs in a clinically-relevant ASDH decompression rat model. Further preclinical studies with longer study duration are warranted to verify the effectiveness of hNSC transplantation in amelioration of TBI induced deficits.

DOI： 10.3389/fneur.2019.00082

Web of Science

PubMed

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

<p>Despite extensive research, the prognosis for patients with severe traumatic brain injury (TBI) remains poor. TBI is the leading cause of mortality and morbidity in young adults worldwide, so it is also a major health and socioeconomic problem. The most important factor determining prognosis is the severity of the primary brain injury, but if the primary injury leads to delayed secondary brain damage, this also combines to determine outcome. A key strategy in TBI treatment should, therefore, be surgical management of the injury and intensive care to prevent additional secondary brain injury. To achieve optimal and seamless care for patients with TBI, clinicians need an adequate understanding of the pathophysiology and mechanisms of TBI, and a universal strategy for its treatment must be established. This paper focuses on the pathophysiological basis of primary and secondary brain injuries, and discusses the indications for surgical treatment in each type of TBI.</p>

DOI： 10.1272/manms.15.71

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

日本頭部外傷データバンク(JNTDB)プロジェクト1998・2004・2009・2015登録症例のデータを用い、年齢構成の経年的変化、高齢化率の変遷、高齢患者における重症度・治療法・転帰の変遷、機能的転帰不良群の特徴などについて検討した。結果、年齢構成の変化については、プロジェクト1998のデータでは20〜29歳と60〜69歳がピークとなる二峰性の分布を示していたが、プロジェクト2004以降は20〜29歳のピークが減少し60〜69歳のピークが増大することで一峰性の傾向となり、プロジェクト2015では70〜79歳がピークとなっていた。高齢患者に対する治療法の変遷は積極的治療の割合が増加し、生命転帰は有意に改善していた。機能的転帰不良因子として「75歳以上」「Injury Severity Scoreが25以下」「Glasgow Coma Scaleが8以下」「外傷性くも膜下出血」「脳室内血腫」が抽出された。

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：NATURE PUBLISHING GROUP  

This study aimed to identify neurological and pathophysiological factors that predicted return of spontaneous circulation (ROSC) among patients with out-of-hospital cardiac arrest (OHCA). This prospective 1-year observational study evaluated patients with cardiogenic OHCA who were admitted to a tertiary medical center, Nippon Medical School Hospital. Physiological and neurological examinations were performed at admission for quantitative infrared pupillometry (measured with NPi-200, NeurOptics, CA, USA), arterial blood gas, and blood chemistry. Simultaneous blood samples were also collected to determine levels of neuron-specific enolase (NSE), S-100b, phosphorylated neurofilament heavy subunit, and interleukin-6. In-hospital standard advanced cardiac life support was performed for 30 minutes.The ROSC (n = 26) and non-ROSC (n = 26) groups were compared, which a revealed significantly higher pupillary light reflex ratio, which was defined as the percent change between maximum pupil diameter before light stimuli and minimum pupil diameter after light stimuli, in the ROSC group (median: 1.3% [interquartile range (IQR): 0.0-2.0%] vs. non-ROSC: (median: 0%), (Cut-off: 0.63%). Furthermore, NSE provided the great sensitivity and specificity for predicting ROSC, with an area under the receiver operating characteristic curve of 0.86, which was created by plotting sensitivity and 1-specificity. Multivariable logistic regression analyses revealed that the independent predictors of ROSC were maximum pupillary diameter (odds ratio: 0.25, 95% confidence interval: 0.07-0.94, P = 0.04) and NSE at admission (odds ratio: 0.96, 95% confidence interval: 0.93-0.99, P = 0.04). Pupillary diameter was also significantly correlated with NSE concentrations (r = 0.31, P = 0.027). Conclusively, the strongest predictors of ROSC among patients with OHCA were accurate pupillary diameter and a neuronal biomarker, NSE. Quantitative pupillometry may help guide the decision to terminate resuscitation in emergency departments using a neuropathological rationale. Further large-scale studies are needed.

DOI： 10.1038/s41598-018-34367-x

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier {BV}  

AIM: To clarify whether quantitative assessment of pupillary light reflexes (PLR) can predict the outcome of post-cardiac arrest (CA) patients during the first 72 h after the return of spontaneous circulation (ROSC). METHODS: Fifty adults resuscitated after non-traumatic out-of-hospital CA (OHCA) (mean age 64.1 years old, 36 males) were enrolled in four emergency hospitals. PLR was sequentially measured at 0, 6, 12, 24, 48, and 72 h after ROSC by an automated portable infrared pupillometry. PLR values for each time point were compared between both survivors and non-survivors, and patients with either favourable (Cerebral Performance Category (CPC) 1 or 2) or unfavourable neurological outcomes. RESULTS: Twenty-three patients survived for 90 days after CA, and 13 patients achieved favourable neurological outcomes. The PLR values of the survivors and patients with favourable neurological outcomes were consistently greater than those of non-survivors (P < 0.001) and those with unfavourable neurological outcomes (P < 0.001), respectively. The change in PLR over time was not statistically different between the outcome groups. The 0-hour PLR best predicted both 90-day survival (AUC = 0.82, cutoff 3%, sensitivity 0.87, specificity 0.80) and favourable neurological outcomes (AUC = 0.84, cutoff 6%, sensitivity 0.92, specificity 0.74). No patient with a 6-hour PLR less than 3% survived for 90 days after CA. CONCLUSIONS: Quantitatively measured PLR was consistently greater in survivors and patients with favourable neurological outcomes during the 72 h after ROSC. Quantitative assessment of PLR at as early as 0 h has a potential role for prognostication in post-CA patients.

DOI： 10.1016/j.resuscitation.2018.06.027

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

Aim: In Japan, standard prehospital care is provided by emergency medical services teams. Doctor-staffed ambulances play a role in facilitating the immediate treatment of critically ill patients to increase the survival rates. However, little is known about their activities. We revealed the present situation of doctor-staffed ambulances in Japan. Methods: First, we surveyed all the fire departments in Japan and determined whether a doctor-staffed ambulance was present within their district boundary. Second, we surveyed hospitals that operate doctor-staffed ambulances in their system to list their activities during a 1-week period. Results: Of 133 hospitals that operated a doctor-staffed ambulance, 73 (55%) replied to our questionnaire. Only 26 (36%) of them provided 24-h ambulance deployment. Additionally, 51 (70%) of hospitals bore the operational costs of ambulances. Within 1 week, 345 doctor-staffed ambulances were dispatched, but 97 (28%) were cancelled. In total, 62 patients (28%) were diagnosed with cardiac arrest, 48 (19%) with trauma or burns, 36 (15%) with stroke, and 22 (9%) with acute coronary syndrome; 159 (58%) were transferred to a tertiary emergency medical center. Conclusions: Doctor-staffed ambulances have the advantage of deployment at night and in urban areas compared to doctor-staffed helicopters. Among the 73 hospitals that responded to the questionnaire, doctor-staffed ambulances were dispatched almost as frequently as doctor-staffed helicopters. However, doctor-staffed ambulances did not receive adequate funding. Future data collection is necessary to determine the efficacy of doctor-staffed ambulances among hospitals that operate this service.

DOI： 10.1002/ams2.347

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MDPI} {AG  

The Japanese Association for Acute Medicine Committee recently proposed a novel classification system for the severity of heat-related illnesses. The illnesses are simply classified into three stages based on symptoms and management or treatment. Stages I, II, and III broadly correspond to heat cramp and syncope, heat exhaustion, and heat stroke, respectively. Our objective was to examine whether this novel severity classification is useful in the diagnosis by healthcare professionals of patients with severe heat-related illness and organ failure. A nationwide surveillance study of heat-related illnesses was conducted between 1 June and 30 September 2012, at emergency departments in Japan. Among the 2130 patients who attended 102 emergency departments, the severity of their heat-related illness was recorded for 1799 patients, who were included in this study. In the patients with heat cramp and syncope or heat exhaustion (but not heat stroke), the blood test data (alanine aminotransferase, creatinine, blood urea nitrogen, and platelet counts) for those classified as Stage III were significantly higher than those of patients classified as Stage I or II. There were no deaths among the patients classified as Stage I. This novel classification may avoid underestimating the severity of heat-related illness.

DOI： 10.3390/ijerph15091962